Dental Students' Attitudes Toward Community Service Following Service-Learning Activities: A Pre–Post Survey Study in Chile

Technical Summary: Dental Students' Attitudes Toward Community Service Following Service-Learning Activities

Problem Statement
Historically, dental education has prioritized technical and biological competencies, often neglecting the social determinants of health and the cultivation of socially responsible professionals. While service-learning (SL) is recognized globally as a pedagogical strategy to bridge community engagement with academic goals, empirical evidence regarding its impact on dental students in Latin America is scarce. Specifically, there is a lack of data from Chile, a country with persistent socioeconomic disparities in oral health access and a recent policy mandate (Vinculación con el Medio) requiring community engagement in higher education. This study addresses the gap in understanding how structured SL activities influence the attitudes of Chilean dental students toward community service.

Methodology
The study employed a quasi-experimental pre–post survey design conducted between August and December 2025 at a Chilean university.

• Participants: Undergraduate dentistry students participating in institutional outreach programs (convenience sample). Of 162 students completing the pre-test, 77 were successfully matched with post-test responses using anonymous self-generated codes for the final analysis.
• Intervention: A 15-week community-based educational program involving two 3-hour sessions per week. Activities included oral health promotion, preventive education, and basic clinical screening in schools, community centers, and primary care facilities.
• Instrument: A validated Spanish adaptation of the Community Service Attitudes Scale (CSAS), a 10-subscale Likert-type instrument (46 items). The subscales measured were: awareness, actions, ability, connectedness, norms, empathy, costs, benefits, seriousness, and intention.
• Procedure: Surveys were administered online before the intervention and three weeks post-intervention to minimize response-shift bias.
• Analysis: Data were analyzed using RStudio. Internal consistency was assessed via Cronbach's alpha. Changes in subscale scores were evaluated using repeated-measures mixed-model ANOVA, treating participant identity as a random effect. Statistical significance was set at p < 0.05.

Key Results
The analysis revealed statistically significant changes in three of the ten CSAS subscales, while the remaining seven showed no significant change:

1. Empathy: Showed the most substantial improvement, increasing from a least-squares (LS) mean of 3.18 (pre-test) to 4.34 (post-test) (p < 0.001).
2. Norms: Demonstrated a significant increase from 4.44 to 4.56 (p = 0.036), indicating a stronger internalization of prosocial principles.
3. Perceived Costs: Significantly decreased from 4.21 to 3.44 (p < 0.001), suggesting a reduction in perceived barriers (e.g., time sacrifice, lost leisure) to community engagement.

Subgroup Analysis:

• Academic Level: Junior students reported significantly higher perceived costs compared to intermediate and senior students (p < 0.05). No significant differences were found in norms or empathy based on academic level, gender, or prior community service experience.
• Ceiling Effect: The lack of change in seven subscales (awareness, actions, ability, connectedness, benefits, seriousness, intention) is attributed to high baseline scores (ranging from 4.13 to 4.54), suggesting a ceiling effect where students already held favorable attitudes prior to the intervention.

Key Contributions and Claims of Significance
The paper claims to provide the first systematic evidence from a Latin American setting regarding the impact of service-learning on dental students' attitudes. Its primary contributions include:

• Empirical Validation: The study confirms that SL activities can significantly enhance empathy and social norms while reducing perceived barriers to community service among dental students in Chile.
• Curricular Implications: Contrary to the notion that community experiences should be reserved for advanced clinical years, the findings suggest that early integration of SL is beneficial. The data indicates that junior students, despite initially perceiving higher costs, benefit from these experiences to develop professional identity and social responsibility.
• Contextual Relevance: The findings support the formal incorporation of SL into dental curricula in middle-income countries facing health inequities. By fostering empathy and a deeper understanding of socioeconomic determinants of health, SL prepares graduates to address the needs of underserved populations more effectively.
• Methodological Note: The study highlights the importance of retaining the full 10-subscale structure of the CSAS (including empathy as a distinct factor) rather than relying on reduced factor models, as this allowed for the detection of significant changes in specific attitudinal domains.

Limitations
The authors acknowledge limitations including the lack of a control group (restricting causal inference), the use of a convenience sample (limiting generalizability), and potential variability in the intervention's implementation. They suggest that future research should employ longitudinal, randomized, or controlled designs with mixed-methods approaches to further elucidate the mechanisms of attitudinal change.