ACM Logo  An ACM Publication  |  CONTRIBUTE  |  FOLLOW    

Facing Global Health Crises Using Mobile Communications: An international virtual exchange experience

By Rosalie Barreto Belian, Lucas Sampaio Leite, José Luiz Lima-Filho, Laura Geer / July 2020

Print Email
Comments Instapaper

Developing human resources capable of contributing positively to solving global problems is a current challenge. In this sense, higher education courses need to be deeply transformed to comprehend and deal with worldwide problems, regarding local, regional, and global contexts. Moreover, societal influences and its increasing complexity add to the challenges of interactivity promoted by globalization, which we are currently experiencing.

In these terms, many Brazilian universities have still outdated curricula and proposals to prioritize technical knowledge is sometimes completely dissociated from societal needs. On the other hand, American higher-education institutions oftentimes fail to consider in their coursework many of the serious problems faced by developing countries, such as the effects of poverty, lack of sanitation and health policies, low levels of education, and the power of incorporating cultural values in proposed solutions. The recent coronavirus pandemic is a prime example with vast geographic and cultural differences in risks for SARS-CoV-2 transmission and COVID-19.

Considering this scenario, cross-cultural teaching and learning experiences are becoming more and more significant in a way that may promote the sharing of information, knowledge, and values, and, thus, contribute to preparing professionals for collaborating in teams capable of solving global health problems.

Cross-cultural experiences have been stimulated by the internationalization of teaching and learning in universities. Especially in Brazil, universities are facing many barriers in the ability to send their students to study abroad and prepare them to address global problem-solving. In this sense, programs based on internationalization at home constitute a feasible way to accomplish cross-cultural experiences.

United Nations' Sustainable Development Goals (SDGs) attempt to address global challenges, in such a complex world scenario, and to stimulate global actions addressing the main challenges we are facing, considering human, social, environmental, infrastructure, economic and political issues [1]. In this context, Goal 3 refers to the importance of the promotion of good health and well-being for sustainable development. In this direction, the World Health Organization, in its 71st Assembly (May 21, 2018), recognized the potential of digital health to improve SDGs and in particular Goal 3, regarding the “support of health promotion and prevention, improving accessibility and quality of health services [2].”

Thus, our international virtual exchange experience was based on a digital health course using mobile communications to prepare for and address potential health crises, with the goal of our students may develop skills to collaborate in teams formed by health workers from diverse cultural backgrounds and countries. Here, we report on the development and implementation of a three-week-long international module that was carried out over two semesters in 2019 at Federal University of Pernambuco and the SUNY Downstate School of Public Health.

Shaping an Undergraduate Module Joining Brazilian and American Students

Our international experience was shaped in the context of COIL (Collaborative Online International Learning), in the SUNY program, through a partnership between a Brazilian university located in Recife, a city in northeast Brazil, and an American one located in Brooklyn, New York.

At Federal University of Pernambuco, this experience was promoted by an institutional project, which aims to encourage the connection of activities developed in collaboration between students from different countries through active teaching-learning methodologies, using digital technologies [3].

At the time of course development, Recife and Brooklyn were facing many local public health problems, such as Zika virus infections [4, 5], with an array of challenging risk factors and contexts. We proposed a shared module intending to guide students in the identification and analyses of their specific local health contexts. As part of the collaboration, students would need to describe the context and identify government policies and regulations developed to address these issues. They needed to become familiar with and share the characteristics of their local population. Local contexts and their specificities would be compared and discussed leading students to study and propose solutions together based on mobile technologies according to the needs and requirements of each context. So, the main learning outcome was defined as: "Students should be able to analyze specific population contexts regarding communication resources and propose communication strategies to face health crises." To achieve this main goal it was necessary to fulfill three intermediate sub-goals, depicted in Figure 1.

To achieve each sub-goal, represented by a different color, a set of platforms/tools/devices were used such as G Suite, YouTube, Zoom, and participants’ cellphone cameras. These tools were used to allow video meetings and video streaming systems to promote multicultural exchange between students from both countries. From the perspective of students' skills development, tools were used to allow the creation of shared documents and application of surveys in each local context. All disciplinary knowledge was continuously assessed using virtual classroom tools.

Figure 1. Student learning outcomes and the platforms/tools/devices used.

[click to enlarge]

We, the partners, followed a number of steps to design our shared module (presented in Figure 2). Our common interests and complementary knowledge and skills were combined to build the proposal. The Brazilian university created a new course (digital health) to host the shared module, while the American university used an existing one (built environment). The built environment encompasses the physical built world in which we live, including buildings, streets, types of transportation, green space, and other features in our environment that influence our health and wellbeing. As part of the attendance policy, we allowed students from any undergraduate course at the Brazilian university to enroll, while the American university offered the shared module just for students enrolled in the public health undergraduate program.

Figure 2. The main steps followed to design the international module.

[click to enlarge]

Each defined learning goal could be achieved by a set of tasks built in a collaborative way by students including reading activities, online discussions, synchronous online meetings, and the writing of a document presenting proposed communication strategies to address health crises. We based the proposal on a flipped-classroom approach by doing individual direct instruction before the collaborative activities. Thus, teachers acted as mediators, instead of just providing information, and students became responsible for their own learning process, defining their own learning pace [6]. Thus, goals for each activity and readings to provide tech knowledge and contextual information were defined. We opted for Google Classroom as the platform to present the shared module for both partners' students. This would provide us with open access, which would not be possible with institutional platforms.

Before the enrollment period, the Brazilian institution would inform its undergraduate students about the new course and its embedded international module. This was planned to bring a great diversity of undergraduate students, in spite of the host course of digital health being part of the medicine undergraduate offerings.

The international module was structured into four sections in order to guide students to achieve the planned learning outcomes:

  1. Team science–ice breaker. Students should record short introductory videos (maximum two minutes) describing what skillsets they might offer as a member of a team of scientists in helping solve a global health problem. The objective of this session is to get students to interact with each other so that personal, professional, and multidisciplinary interests were tackled and highlighted. In this section, Brazilian and American students should participate together, using free-choice resources such as smartphones for recording videos and editing tools. Videos should be stored using YouTube and include subtitles to facilitate understanding and reduce language barriers.
  2. Group preparation and discussion (first online meeting). During the next week, efforts should focus on reading scientific articles, viewing local news reports, and engaging in online discussions about arboviruses in both local contexts (Brazilian and North American). This step is necessary to build a solid theoretical foundation on pathologies for a multidisciplinary discussion in a multicultural context. This portion of the module is concluded with a synchronous online meeting between teachers and students from both countries. Students would discuss how the epidemics occurred and the coping strategies adopted given the social, political, and cultural differences/similarities in both countries. The synchronous meeting should take place over a period of 40 minutes in the communication platform provided by the Zoom tool, which was chosen because of its compatibility with several devices—both mobile and desktop—in addition to supporting up to 100 users in its free version.
  3. Mobile communications report and group discussion (second online meeting). This stage of students' collaborative work consisted of two phases. Firstly, students should create a survey (e-form) about the population habits related to mobile and online communication channels in each place. The e-form should be developed collaboratively by the students (in English). Brazilian students would need to translate before sending it in their social media (Whatsapp), while American students would send it by email and text messaging. Secondly, students collaboratively should write a report synthesizing the acquired data in the survey (wiki). The report would be discussed in an online meeting mediated by the teachers using the Zoom tool. The discussion should address the previous findings comparing differences and similarities about each place.
  4. Health crises communications proposal. Using the report produced in Stage 3, each group of students should build a document of a proposal for approaches to address health crises using mobile strategies. This document should consider technological resources, population habits, and government policies, among others.  

The Reality: Applying What Was Planned. Challenges/lessons learned?  

The international module took three weeks and was implemented in 2019 twice for both semesters. Twenty students from the Brazilian university participated in the modules coming from several undergraduate courses such as medicine, nursing, physiotherapy, biomedicine, dentistry, information systems, and social sciences. Due to limited enrollment in the host course in the U.S., only 2–5 American students from the public health graduate-level course participated over the two semesters.

During the activities, professors from both universities acted as discussion mediators, facilitators, and support for the participants. Regarding this, it is important to mention the difficulties to engage students, even considering that the course is optional (as was the case with the Brazilian university).

At the module beginning, Brazilian students were asked to answer a brief English proficiency exam. This showed that we had students with a great heterogeneity of English skills. We assisted them by offering the use of resources with translators and subtitles.

Students' profiles were gathered through the presentation of short videos recorded by each participant. These were ice-breaker videos. It was so interesting to watch these videos. Even students in the earlier stages of the undergraduate program explored what they needed to develop and learn to contribute to such teams. They admitted a lack of experience and technical and scientific knowledge to contribute to the team, however, to overcome these limitations some declared to have skills such as creativity, dissemination of information in the communities, skills collecting blood samples, and using social media to better spread information.

Students were able to obtain a sense of multiculturality when they were required to think about their potential role in solving global health crises. An example, in a video recorded by an American student, a woman who is an immigrant, she shared she grew up in different communities with different population cultures, emphasizing that this could help her to better understand the needs and difficulties of a region that is going through a health crisis.

The issue that was most mentioned in the videos was prevention, considered as a key factor to improve global health. Health promotion with emphasis on humanization and also the importance of data analysis in crisis environments were both mentioned by students. Students with a more technological bias proposed to use their skills to use web, mobile, and social media solutions to disseminate information. Another point was the use of wearables and other technologies for health promotion.

Students worked well on the mobile communication survey, producing an e-form, disseminating it online for health professionals from their respective universities, and analyzing the acquired data. However, they had a lot of difficulties to collaboratively write the report, requiring a high level of teacher mediation to achieve the task, and likewise, with the final proposal of mobile communication strategy.

Another major challenge to implementation of this module was the difficulty with synchronous online meetings. Due to the different time zones, we had to schedule the meeting early at night. Even so, we had many absences. We had planned just two online meetings in the whole module, trying to work mostly with asynchronous tasks. However, we continued to schedule online meetings, since they were important to students' development of communication and cross-cultural skills.

In spite of students coming from diverse undergraduate courses, they did not show difficulties in working with health crises subjects. We believe this happened due to the readings and course resources that prepared them to discuss each theme.

Assessment was a challenging task in the module. We proposed some individual tasks and products aimed at facilitating assessment. But, since we wanted to promote teamwork it was difficult to evaluate students in the shared activities. Regarding this challenge, in the next module implementation, we intend to group students in several small groups for better-informed evaluation.

Students Outcomes and Their Experience Evaluation

At the end of the module, students were asked to answer a course evaluation questionnaire with the purpose of gathering students' opinions about the experience. They were informed that the collected data would be used for research purposes only.

In the Brazilian group, the evaluation form of the international module was answered by 11 students, eight students were graduating in medicine (72.7 percent) and the rest were students of nursing, physiotherapy, and information systems courses, with 1 student (9.1 percent) for each course. The applied questions were divided between objective and subjective questions and addressed: (i) the positive and negative points of the students' experience in the module, (ii) the impact of the partnership with the group abroad on the student's education, (iii) difficulties related to interactions between students who speak different languages, (iv) the influence of interactions on students' interculturality, and (v) the digital technologies used.

We had the following opinions:

  • All students felt the international module had a positive impact. Some have suggested more synchronous interactions with foreign students in a new course offering.
  • All Brazilian students considered the interaction with American students in English as useful and beneficial for the development of a second language.
  • 54 percent of the Brazilian students said their notions of interculturality were influenced by the experience, 18.2 percent said perhaps their interculturality notions were influenced, and 27.3 percent denied the influence.
  • 7 percent of students would participate in a course using the COIL (BraVE [Brazilian Virtual Exchange]) methodology again.
  • 9 percent of Brazilian students felt influence on knowledge in terms of their academic curriculum.
  • They mentioned the experience strengths: easy platforms, interculturality, internalization, and health approaches considering different contexts and knowledge exchange.
  • As weaknesses, they mentioned: difficulties with time synchronization and internet failures.

There were limitations in the evaluations provided by the American students, given limitations in class size and timing for the module, and thus, results are not reported here.


This work reported on an international virtual exchange experience based on a digital health course that embedded a shared module with curricula addressing mobile communications to face health crises. The purpose of the experience was for students to develop skills to collaborate in teams made up of health professionals from different countries. They demonstrated these skills at an early stage. They shared presentation videos that were commented on among students, highlighting their main contributions to coping with a health crisis.

The adopted methodologies and tools were approved by the students, where everyone was positively impacted by the discipline: 72.7 percent would participate in another COIL course again and about 91 percent said they had felt a positive influence of knowledge in curricular terms. On the other hand, we report the difficulties of engagement, which is especially needed to apply a student-centered approach, such as flipped classrooms.

With both professors, perceptions of the exchange were regarded highly and with positivity. It was agreed that efforts to further develop and refine the module should continue into the next year. Overall, the collaboration promoted the development of communication and intercultural skills contributing to knowledge acquisition about digital technologies and their potential role in addressing major health crises.

The students were able to analyze specific population contexts concerning their communication resources and propose mobile communication strategies to face health crises. Zika virus outbreak was taken as an example that seriously affected Recife and NYC/Brooklyn in 2015, bringing the strength of reality for the students of both places.

More than ever, we realize how important it is preparing professionals to work on multidisciplinary teams to help and solve health global problems, and thus, we will reapply this experience into the context of the COVID-19 pandemic. Our future study should take into account the perception of the spread of the coronavirus in a multidisciplinary and multicultural context, given the appearance of the disease at different times, with different knowledge and dynamics, beyond government decision-making and cultural aspects that may have affected the spread of the virus in both countries.


[1] United Nations. UN Sustainable Development Goals. 2020,

[2] World Health Organization. Digital health. Draft resolution proposed by Algeria, Australia, Brazil, Estonia, Ethiopia, Germany, India, Indonesia, Israel, Italy, Luxembourg, Mauritius, Morocco, Panama, Philippines, and South Africa. 71st World Health Assembly agenda item, 12, A71. 2018.

[3] UFPE. BRaVE - Virtual Mobility Call. February 2020.

[4] Magalhaes, T. et al. Zika virus displacement by a chikungunya outbreak in Recife, Brazil. PLoS Neglected Tropical Diseases, 11, 11 (2017). DOI:

[5] Greene, S. K., Lim, S., and Fine, A. Identifying areas at greatest risk for recent Zika virus importation — New York City, 2016. PLoS Currents. July 25, 2018. DOI:

[6] Hao, Y. Exploring undergraduates' perspectives and flipped learning readiness in their flipped classrooms. Computers in Human Behavior 59 (2016), 82-92. DOI: 

About the Authors

Rosalie Belian is an associate professor of Digital health and IT for health education in the Federal University of Pernambuco, Recife/Brazil. She earned her PhD in Computer Science at Federal University of Pernambuco. Her research focuses on mobile learning, serious games and health education.

Lucas Leite is a professor and has a Master degree in Applied informatics. He is pursuing his doctorate at Federal University of Pernambuco (LIKA) in Biology applied to health.

José Lima-Filho is a titular professor of Biochemistry in Federal University of Pernambuco and Chair of LIKA (Immunopathology Keizo Asami Laboratory).

Laura Geer is an assistant professor and Chair of the Department of Environmental and Occupational Health Sciences at SUNY Downstate School of Public Health. Dr. Geer received her master's and doctoral degrees from Johns Hopkins Bloomberg School of Public Health in the division of Environmental Health Engineering. Her current research interests include the assessment of maternal attitudes toward prenatal and perinatal education and outreach, with a focus on mobile health strategies.

Permission to make digital or hard copies of all or part of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for profit or commercial advantage and that copies bear this notice and the full citation on the first page. Copyrights for components of this work owned by others than ACM must be honored. Abstracting with credit is permitted. To copy otherwise, or republish, to post on servers or to redistribute to lists, requires prior specific permission and/or a fee. Request permissions from [email protected].

© ACM 2020. 1535-394X/2020/07-3412835 $15.00


  • There are no comments at this time.