In the United States, higher education schools and programs of public health provided significant contribution to the COVID-19 response (2). These entities collectively partnered with local health departments to boost surge capacity through key pandemic response functions such as contact tracing and staff training. With respect to training, students had opportunities to gain meaningful public health experience through practical, service-learning and field experiences (2). A major study examining the impact of this important partnership found that 67% of public health schools that were part of the national organization, Association of Schools and Programs of Public Health and Council on Education in Public Health, partnered with health departments for surge capacity, 63% supported contact tracing, and 37% participated in training opportunities (2). While this provides evidence related to the student contribution to the COVID-19 response, there is a lack of understanding on COVID-19’s impact on public health college students’ continued interest in the field.

Evidence also suggests that COVID-19 generally impacted student learning experiences and outcomes both positively and negatively. Among the positive outcomes reported from the pandemic, noteworthy outcomes included having more time for other professional development activities and the remote option offering flexibility to learn from any location (3–5). Given that pursuing graduate studies is a personal choice for many, students in the Philippines had higher expectations of their learning environment, including from faculty and their teaching methods, as well as feeling an overall sense of belonging (6). In China, the learning material was found to be a significant factor for engagement, even in an online platform, as the content itself facilitated interest and learning among students (7). When these expectations are met, there is a positive correlation with overall satisfaction with an academic program (6, 8, 9). This highlights the role of faculty in ensuring a successful transition to online learning during a phenomenon like COVID-19 where evidence shows that faculty who receive training on how best to deliver educational content in an online learning environment can improve student engagement (10).

Suboptimal impacts on learning experiences were exemplified in Arantes do Amaral et al.’s study (4) among Brazilian graduate students to understand how the pandemic affected learning outcomes. They found that being sheltered in place produced adverse learning outcomes among students since many students reported experiencing digital fatigue and difficulty grasping material through online conferencing platforms. In Brazil, China and Europe, students also reported issues with using new learning technologies (4, 8, 11). These negative experiences are also observed when understanding student social connectedness during the pandemic. Al-Mawee et al. (3) employed a case study to understand student experiences with distance learning during the COVID-19 pandemic using an online survey. Their findings showed that students had overall less social interaction with their peers. Other researchers also found that this sense of social connection was connected to student perceptions and feelings of openness in being able to connect with their peers in a way that helped to develop a sense of community (9, 12, 13). Student levels of social connection may also be connected with their overall level of human interaction either with other students or with faculty, such that decreased human interaction means less engagement with course learning material (14). Understanding learning experiences, outcomes, and social connectedness among students in public health specifically may provide deeper insight into how the COVID-19 pandemic renewed student interest and engagement in the field of public health.

Current mental health research related to the impact of the COVID-19 pandemic on college students’ mental wellbeing used existing assessment scales, such as the PHQ-2 and GAD-2 (15) to determine how mental health outcomes shifted among students before and after the transition to online learning. A handful of studies also incorporated questions to assess similar mental health outcomes in surveys or semi-structured interview guides. Son et al. (16) surveyed 195 graduate students to understand the effects of COVID-19 on mental health and found that 71% indicated heightened stress and anxiety during the outbreak, 89% reported difficulty concentrating, and 86% reported decreased social interactions and academic performance. Students from universities based in New York and New Jersey participated in a survey (n = 4,714) to understand academic, financial, and COVID-19-related stressors that impacted their learning (17). Results showed that the pandemic adversely affected their mental health overall, with most stating feeling down, depressed, hopeless and socially isolated during this time. Chrikov et al. (15) also conducted a similar study to understand mental health outcomes among more than 30,000 undergraduate and 15,000 graduate students from different universities participating in UC Berkeley and University of Minnesota’s Student Experience in the Research University (SERU) project. They found that adverse mental health outcomes were higher among students overall compared to pre-pandemic, and that those who struggled with adapting to remote instruction technologies were more likely to experience worse outcomes compared to their peers. It was also noted that students from different minoritized groups, such as low-income students and students of color, had poorer mental health outcomes (15). These combined results are consistent with findings from other studies that examined similar mental health outcomes resulting from the transition to online learning during the COVID-19 pandemic (13, 18, 19).

Specifically among students enrolled in health-related degree programs, there is limited research on mental health that focuses on the public health student population. There is, however, research from the field of nursing such as Rosenthal et al. (20) study that focused on understanding how mental health impacted nursing graduate students during the pandemic where similar health outcomes were observed. This is one of a limited number of studies that discusses mental health among graduate students from health-related academic programs; most current studies only focus on nursing programs. While Rosenthal et al. (20) study found similar mental health outcomes as those that were aforementioned, it is important to note that each academic training program is structured differently and has a variety of requirements. In many public health degree programs, graduate students do not have requirements to complete clinical hours but they may be required to complete a fieldwork experience that may introduce varying levels of complexity and stress to the student’s workload depending on their fieldwork placement.

The purpose of this study was to understand the extent to which public health graduate student perceptions of learning experiences, social connectedness and mental health were impacted by the COVID-19 pandemic. We explored the perspectives of graduate students enrolled in the San José State University Master of Public Health (MPH) program, campus-format, located in San José, California. We sought to understand these factors to identify actionable pedagogical implications that directly inform future academic curriculum, instruction, and fieldwork experiences in this program.

This study was conducted within the San José State University MPH program, housed within the Department of Public Health and Recreation. The MPH program has been accredited by the Council on Education for Public Health since 1974 and offers an MPH degree with a specialization in Community Health Education. Students are able to apply for one of two degree format options: (1) campus and (2) online. Students in the campus program have opportunities to participate in a range of extracurricular activities, such as joining student clubs, visiting the student wellness center, and participating in intramural sports. In February 2020, the campus program was shifted to online to comply with local shelter in place orders, resulting in 100% of campus-based classes shifting to online format using Zoom technology. Students resumed in-person classes in a phased approach starting in Fall 2022 (August 2022) and through the Spring 2023 (January 2023) semesters.

This was a convergent mixed-methods study to understand the combined effects of COVID-19 on graduate student learning experiences, social connectedness, and mental health. The quantitative aspect of this study implemented a retrospective pre-and-post research design using a survey instrument. The survey was followed by the qualitative aspect which employed semi-structured interviews using a phenomenological approach. Phenomenological research is a type of qualitative design that aims to obtain a rich understanding of participant life experiences as they relate to a particular phenomenon (21). In our study, this phenomenon was defined as the COVID-19 pandemic, where we recognized that students who experienced this phenomenon were required to transition to online learning and then transition back to in-person learning once government safety laws were rescinded. Given this, students had a unique experience with COVID-19, which we sought to explore further through a phenomenological approach.

Through our design, we investigated the following research question: How did the transition to online learning impact campus student learning experiences, social connectedness and mental health? This included the following sub questions:

This study was approved by the San José State University Institutional Review Board.

We used a stratified sampling strategy to identify and email students enrolled in the campus-format MPH Program during the 2017–2020 academic years who first transitioned to online learning and then back to campus learning during COVID-19. Eligible participants must have been attending classes on campus before the pandemic started. We also posted recruitment flyers on our social media platforms that contained a link to a survey. This survey contained screening questions to determine eligibility for study participation.

Interested students completed the screening questions and, if eligible, reviewed a consent notice and completed the quantitative survey. The survey took approximately 15–20 min to complete and assessed student demographics and learning experiences before and during pandemic. At the end of the survey, participants were asked if they were interested in being contacted by a member of our research team to participate in a follow-up qualitative interview. For participants that opted to participate in the interview, they reviewed a separate consent form and were then scheduled an interview with either the third or fifth author. The interviews took approximately 45–60 min. Individuals who completed the survey received a $20 gift card incentive. For those participating in the semi-structured interview, they received an additional $30 gift card.

To analyze the survey responses, raw data were first exported from Qualtrics into Microsoft Excel and reviewed for completeness and eligibility. All incomplete and ineligible response data was removed from the final dataset (Figure 1). The final dataset was then analyzed using descriptive statistics in SAS that displayed overall participant demographics (Table 2) and a comparison of overall pre and during COVID responses (Table 3). The comparison data were analyzed using the Wilcoxon signed rank test.

Participant interview data were analyzed using codebook thematic analysis (22). A codebook was created to establish an initial theme of codes based on the semi-structured interview guide. All recorded interviews were then transcribed verbatim and coded by two members of the research team. The data were then grouped by code and analyzed to identify themes. The first and third authors reviewed and finalized these themes for inclusion in our results.

All participants praised faculty for their support before and during the pandemic, especially while adjusting to a new “normal” learning environment. Participants were further appreciative of the number of faculty from diverse sociocultural backgrounds and experiences, who fostered a relatable and inclusive learning environment. Some participants indicated that faculty support never wavered throughout the pandemic; rather, there were notable shifts in the way this support was provided during the pandemic. For example, faculty continued to offer office hours, but switched modalities to remote platforms during the transition to online learning.

Participants shared:

These reflections highlight the overall positive faculty support that the students received during the COVID-19 pandemic, where faculty were thoughtful in sharing their lived experiences during their courses and proactively worked with students to adjust their study environment for improved productivity.

Most participants stated that their sense of community within the MPH program shifted before and during the pandemic. Some indicated that in-person classes simply made it easier to collaborate while online learning felt more isolating. Students could simply turn to their peer’s desks while in the same classroom together, whereas that was impossible to do in a virtual classroom. As a result, participants stated having to be more intentional and creative to find ways to work together with their peers in an online environment overall.

When reflecting on pre-pandemic experiences, one participant stated:

When reflecting on how these experiences changed during the pandemic, one participant stated:

These excerpts illuminate the value that students place in being able to work closely with their peers to do well in their academic program. There is importance in establishing an initial in-person connection with classmates in order for students to feel comfortable contacting them after class if they need more help.

For students, knowing their cohort members before the transition helped sustain relationships and maintain a sense of social connectedness. However, students that were in classes with members from a newer cohort found it hard to connect with them due to cameras not being on and varying participation levels. Participants overall found it harder to brainstorm with their peers on the online platform.

Participants stated:

Overall, students felt much more disconnected from their peers in the online learning environment since there were fewer opportunities to have in-person, human interactions with others.

This section saw mixed responses from participants. A couple of participants stated experiencing positive mental health outcomes after the online transition which was attributed to the opportunity to have more time at home and with their family members. However, others reported feeling more isolated and had reduced motivation to do well in their classes.

Participants stated:

All participants agreed that COVID-19 brought greater awareness of the impact and complexities of working in public health.

Participants stated:

This highlights one positive aspect of the online learning transition in that public health students obtained a richer sense of public health practice and how academic concepts are implemented in a real-world setting. The pandemic also provided students with a sense of how much impact public health practitioners can have in the community.

Most participants stated that having more time at home, less commute time, increased time with family, and linkage to campus resources all facilitated better learning experiences during the pandemic. A major barrier was reported as less opportunities for networking or relationship building with others on campus.

Participants stated:

Higher education institutions and faculty within public health programs have a critical role to play when transitioning their students from campus to online teaching formats or vice versa. Careful consideration around curriculum design to ensure it meets the needs of students who are enrolled in a range of learning modalities, such as hybrid, in-person or online, can help maintain a positive learning experience for students (10). Educational institutions may also consider conducting focused studies to better understand how public health curriculum should be designed to best meet these needs, including adopting newer evidence-based pedagogical frameworks to facilitate meaningful online learning (25). Specifically for public health academic programs that offer a majority of courses in an online format, Dabbagh (25) pedagogical framework recommends incorporating a combination of instructional strategies, learning technologies and activities that are tailored for the online environment, to benefit from a triadic interaction between these three concepts to increase student learning experiences. As part of this, it remains important for faculty to continue to play an active and intentional role in the learning environment, be cooperative, constructive and authentic in their course delivery approaches for students to remain engaged in the course (25).

Our study participants indicated a preference for shifting to hybrid academic models as a way to balance work-life commitments which would also reduce mental health concerns. This is consistent with recent studies that aimed to understand whether hybrid learning is effective and in particular, whether in-person presence really matters (26, 27). These authors urge educators in higher education to consider implementing a thoughtful approach to redesigning programs to be hybrid models such as by incorporating training for both faculty and students on the new teaching platforms, such as Canvas or Blackbaud, that will be used to provide instruction. While this may require a cost investment and faculty planning committees from the start, hybrid programs may have a far-reaching impact on students who may otherwise struggle to maintain work-life balance while enrolled in their public health academic program. Students who have other financial obligations may find it easier and more cost-effective to attend classes a few days per week in-person as opposed to daily in-person attendance. It may also simply be much more convenient for the student body overall to enroll in hybrid programs. From a social connectedness and community belonging standpoint, hybrid programs may enable students to develop relationships with their peers and other faculty and participate in campus activities depending on their scheduling preferences rather than around required times when classes are scheduled to be held in-person (28). Therefore, educational practitioners are encouraged to offer hybrid academic programs and establish resource infrastructures that provide students with social and mental wellness support when transitioning to different learning modalities.

Our study results are not generalizable due to the small sample size of the quantitative component; however, using a phenomenological approach to gather qualitative data provided the research team with deeper insight into student learning experiences while transitioning from campus to online learning. This provides public health academic departments valuable recommendations and insights in the event of future mandated modality shifts in learning environments. Future studies should include a larger sample size that is representative of a wider geographical region and that considers cultural representativeness; future studies should also evaluate hybrid models to determine their feasibility in different higher education contexts and among program faculty.