A major decision: an exploratory study of influences on the choice of the Health Promotion major.
Abstract: In order to determine the factors which had the strongest influence on students' choice to major in Health Promotion, 80 Health Promotion students completed a questionnaire related to when they chose the major, how they discovered the major, and the strength certain influences had on their choice. The most prominent factors influencing major choice were "Believing that Health Promotion is important in today's society" and a "Desire to make difference in the world through career choice". Results of this study will be helpful in both recruitment of additional students to Health Promotion and understanding the motivation of current students.
Article Type: Report
Subject: Career development
Universities and colleges
Career choice
Authors: Roberts-Dobie, Susan
Sirowy, Lindsey
Pub Date: 01/01/2009
Publication: Name: American Journal of Health Studies Publisher: American Journal of Health Studies Audience: Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 American Journal of Health Studies ISSN: 1090-0500
Issue: Date: Wntr, 2009 Source Volume: 24 Source Issue: 1
Product: Product Code: 9918560 Career Planning; 8220000 Colleges & Universities NAICS Code: 61131 Colleges, Universities, and Professional Schools SIC Code: 8221 Colleges and universities
Accession Number: 308743755

Although some students enter college sure of their course of study, most switch between fields or put off' declaring a major until they find a good fit. Of the freshman who declare a major, 72% will switch majors before graduating (Kroc, Howard, Hull & Woodward, 1997). While it is important for students to diligently search for a major until they find a good fit, late decision making and changing majors can have a negative impact on students. These students will find it more difficult to graduate in four years, their classes are often not sequenced well, and there may not be time for optional internship opportunities or the addition of a supporting minor (Strasser, Ozgur, & Schroeder, 2002). Colleges and universities have traditionally helped students find a "good fit" of major through advising services or career aptitude testing. However, there is little established literature on why students are drawn to a specific college major.

While no "theories of major choice" exist, there are strong theoretical foundations in the field of career choice and development. An argument can be made that this literature is applicable. The choice of college major can be viewed as a proxy for a career choice, as in essence, when a person chooses a major, they are choosing to prepare for a career in a given field. Career choice and development theory emerged in 1909 when Frank Parsons proposed a three-step framework for choosing a vocation. He wrote,

In the wide choice of a vocation there are three broad factors: (1) a clear understanding of yourself, your aptitudes, abilities, interests, ambitions, resources, limitations, and knowledge of their causes; (2) a knowledge of the requirements, conditions of success advantages and disadvantages, compensation, opportunities, and prospects in different lines of work; and (3) true reasoning on the relations of these two facts (Parsons, 1909, p. 5).

While career development theory has evolved significantly over the past century, these tenets remain at the core; a person must know what he is good at and then find a job that is acceptable to him and in line with his talents.

Mid-century, career development theories shifted to Life-Span models, where career choice was viewed as an ongoing process throughout the lifespan, rather than a one-time choice at the beginning of working age (Super, 1953). More recently, theory turned toward more individualistic models, such as John Holland's Type theories (1973). As a military interviewer during World War II, Holland's job was to assign jobs to new soldiers based on their skills. He identified six personality types that emerged when soldiers described their interests, skills, and self-assessments. The personality types and jobs included: (1) Realistic (mechanical jobs, such as electrician or surveyor); (2) Investigative (chemist, anthropologist); (3) Enterprising (salesperson, executive); (4) Artistic (writer, actor); (5) Conventional (accountant); and (6) Social (teacher, psychologist). These categories served as the basis for the Self-Directed Search (SDS), which became, and remains, the most popular career inventory in the world. More than 20 million people have taken the inventory to determine occupations at which they may excel (Holland, 1985; Minor, 1992; Psychological Assessment Resources, n.d.).

Although dozens of career development theories now exist and each differs in the details, one tenet held constant by most is that a "good fit" will lead to employment satisfaction and that employment satisfaction is necessary for life satisfaction. Super perhaps phrased it most succinctly, when he wrote, "Work satisfactions and life satisfactions depends upon the extent to which the individual finds adequate outlets for abilities, needs, values, interests, personality traits, and self-concepts" (1990, p. 208). This theme of "good fit" is also reflected in the work of Krumboltz (1979). His social learning theory of career decision making specified three factors that influenced career decision making: genetic endowment, environmental conditions, and learning experiences. He identified genetic influences as sex, race, physical appearance, and special abilities, such as intelligence or artistic abilities. Environmental conditions included training opportunities available, rewards for various occupations, and the influence of family and other important figures. Learning experiences include both instrumental (direct) and associative (vicarious) learning experiences. Experiences such as being successful at a task are instrumental, while attitudes developed by observations of other's actions are associative. Krumboltz theorized that the interaction of these factors resulted in a set of skills a person believes she is good at--leading to action--the choice of an occupation (Krumboltz, 1979; Minor, 1992).

In an attempt to apply Krumboltz's career development theories to the choice of a college major, we can consider the impact of genetic endowment, environmental conditions, and learning experiences, both instrumental and associative. While there is no existing literature regarding influences on major choice in the field of Health Promotion (or the related fields of Health Education or Public Health), this has been studied in the fields of Accounting, Business, and Chemistry. Factors found to impact students' choice of major include interest in the subject, having a high aptitude for the field, influence of the instructor in an early course, career opportunities, parental influence, self-efficacy, lifestyle the career offers, financial compensation, job satisfaction, job availability, challenge related to job, having had an inspiring high school teacher in the field, and knowing someone who works in the field (George, Wystrach, & Perkins, 1985; Mauldin, Crain & Mounce, 2000; Strasser, Ozgur, & Schroeder, 2002). All of these factors can be classified in Krumboltz's typology--high aptitude (genetic endowment); instructor influence, parental influence, inspiring high school teacher, career opportunities, financial compensation, and job availability (environmental conditions); self-efficacy, interest in the subject, and challenge (instrumental learning experiences); lifestyle, job satisfaction, and knowing someone who works in the field (associative learning experiences).

This study attempts to determine which factors are highly associated with the choice of the Health Promotion Major and which type of influence (environmental conditions, instrumental learning experiences, or associative learning experiences) is most powerful. This exploratory descriptive study asks these questions for two reasons. First, the projection of need for workers in the fields of health promotion and public health is rising, especially in the area of environmental health (Bell & Khodeli, 2004). In order to meet the future demands, Health Promotion faculty will need to work to recruit more students into their programs. Secondly, decreases in secondary school enrollments are projected in 18 states and the District of Columbia between 2003 and 2015 (National Center for Education Statistics, 2006). Thus, in many states, we will have more jobs to fill and fewer college students available to be trained to fill them. This scenario necessitates that Health Promotion programs market their Major to students who may be unaware that the Major exists or what Health Promotion career paths have to offer.


In order to determine if the factors that have been shown to influence Accounting, Business, and Chemistry students also influence Health Promotion majors, a questionnaire was developed by the authors based on a comprehensive review of the literature. The questionnaire was comprised of 34 questions, including 8 demographic questions and 26 questions related to when and why students chose the Health Promotion major. After receiving Institutional Review Board approval, the questionnaire was piloted with three students. The questionnaire was also reviewed by five Health Promotion faculty members and one Academic Advising employee who frequently works with prospective Health Promotion students. After piloting and review, minor wording changes were made for clarification and two "reasons" for majoring in Health Promotion were added to the questionnaire. Piloting and review showed the instrument face validity. As factors previously found to influence major choice were included in the questionnaire, in addition to factors identified through pilot testing, content validity is also assumed.

The study was conducted at a mid-sized state university in the Midwest. At the time of data collection, the Health Promotion Division had 99 declared majors and eight full time faculty, in addition to multiple adjunct faculty. The Health Promotion curriculum at this university is built around the CHES competencies and designed so that all students are prepared to sit for the CHES exam upon graduation. For example, the curriculum includes courses dedicated to teaching planning, implementing, and evaluation health programs, as well as coursework in health advocacy and epidemiology.

A blanket sample of all students declared as Health Promotion majors in Spring Semester 2007 was attempted by distributing the questionnaires and consent forms in six Health Promotion courses with large enrollments. Students who were absent from class or not enrolled in those courses were contacted by e-mail and asked to pick up and complete a survey. Questionnaires were mailed to those students who did not pick up a questionnaire and to those students completing off-campus internships.

Descriptive statistics, t tests, and correlations were used in data analysis. Data analysis was performed using SPSS 14.0 for Windows. A p value of .05 or less was considered statistically significant.


Eighty students completed usable surveys. Of the 99 students declared as Health Promotion majors in Spring 2007, three students indicated plans to change majors soon and chose not to complete the survey. Seven additional students indicated they planned to declare the major, but had not yet done so. Surveys completed by 73 currently declared majors of the 96 possible plus the 7 students with plans to declare provided an 83% response rate. Participants were 89% female and 11% male, which is reflective of the make-up of the entire major (90% female), but not the campus as a whole (56% female). Respondents included 5 freshman (6.3%), 15 sophomores (18.8%), 24 juniors (30%), and 36 seniors (45%). The mean age of students was 21.6 (SD = 3.51, range = 18-47) and the mean GPA was 3.15 (SD = .44).

The first goal of the study was to identify influences on students' decisions to major in Health Promotion (see Table 1). Seventeen questions regarding influences were derived from the existing literature and through discussion with students and Academic Advising staff. Influences were measured on a scale of one to five (where 1 = not at all influential and 5 = extremely influential). Students reported that the two most influential factors in their decision to major in Health Promotion were that "Health Promotion is important in today's society" and a "Desire to make difference in the world through career choice" (M = 4.54 and 4.23, respectively). Interest in coursework was also highly influential (M = 4.10). Factors with the weakest influence included the required Personal Health course (M = 1.79), a high school health teacher (M = 1.77), and high school guidance counselors' recommendation to study Health Promotion (M = 1.33).

Influential factors did not vary by grade point average, perception of ease of the major, or if Health Promotion was the first degree pursued. There was, however, some variability based on emphasis. Within the Health Promotion major at this University, students choose an emphasis area. All students are required to complete a core set of courses and internship equaling approximately 40 semester credit hours. Additionally, each student selects an emphasis in which to complete approximately 15 additional semester credit hours of coursework. Although due to recent curricular revisions, the names of the emphases have been revised, current students are earning emphases in Worksite Health Promotion/Wellness, Women's Health, and Cultural Competency/Global Health. It should be noted that although a Science-Intensive Environmental Health Emphasis was added this year; however, these students were not included in the analysis by emphases due to small numbers. It should also be noted that due to overlap of students choosing to emphasize in both Women's Health and Cultural Competency, the following analysis was performed defining students via a dummy variable as either Worksite/Wellness students or not. This created two groups, Worksite/ Wellness students (n = 44) and a combined group of Women's Health and Cultural Competency/Global Health students (n = 27).

Although these two groups did not vary significantly by grade point average, perception of ease of the major, or if Health Promotion was the first degree pursued, they were influenced differently by three of the seventeen factors. Worksite/Wellness students were significantly more likely to indicate their participation in sports and physical activity was influential in their choice to major in Health Promotion (t = 3.92, p < .01). Worksite/Wellness students were also more influenced by perceived job availability in the field (t = 2.55, p < .05). Women's Health and Cultural Competency students, however, were more likely to identify a desire to make a difference in the world via their career choice as an influential factor (t = -2.04, p < .05).

When the influences on students' decisions to major in Health Promotion were categorized (see Table 2) into the Krumboltz typology of environmental conditions, instrumental learning experiences, and associative learning experiences, significant differences emerged. Students reported that the influences identified as instrumental learning experiences were significantly more influential on their choice of major than those identified as either associative learning experiences or environmental conditions (M = 4.11, 3.50, and 2.05, respectively). Additionally, associative learning experiences were significantly more influential than those identified as environmental conditions.

The portion of the survey regarding how students discovered the Health Promotion Major revealed many interesting results. One of the most surprising findings was when students decided to pursue a health-related profession. Forty-eight participants (60%) indicated they had chosen a health-related field prior to attending college. Of these, 11 made the decision before high school, 30 during high school, and 7 between high school and college. Fifteen participants (19%) indicated their interest began after taking a health-related course in college.

While 19% of students reported declaring Health Promotion as a major as a freshman, 43% declared the major as a sophomore, 35% as a junior, and 1% as a senior. For 29% of the students, Health Promotion was the first major they pursued. The other 71% had pursued a variety of majors before declaring a Health Promotion major. Commonly reported majors pursued before Health Promotion were Education (n = 16), Psychology (n = 8), Marketing (n = 6), Biology (n = 5), and Athletic Training (n = 4). As these majors are all related in some way to Health Promotion, previous coursework in these majors would continue to benefit these students after switching majors. The high number of students reporting Health Promotion as a second or third major choice echoes Kroc, Howard, Hull and Woodward's report (1997) that 72% of freshman who declare a major, switch before graduation. Additionally, the one-third of participants who did not declare the major until their junior year suggests that Health Promotion may be a "found major", a field of study that students may not know exists until after being exposed to it in college.

Given its "found major" status, it is of special interest to learn how students first discovered the Health Promotion major. Students indicated that two sources were especially useful. Twenty-one students (26%) identified the university webpage as their "discovery point" and another 21 (26%) students indicated they had learned of the major from another student. Seventeen (21%) were informed of the major through the Academic Advising Office. Nine students learned of the major through a professor, while only three learned of it at freshman or transfer student orientation.

To determine if students were drawn to the major because of perceived ease of coursework, students were asked to rate the difficulty of the coursework compared to other majors (much easier than other majors = 1, equal = 3 and much harder = 5). No students responded that the coursework was either much easier or much harder than other majors. The mean self-reported difficulty was 2.82 (SD = .53), corresponding to a student perception of the coursework being almost equal, although slightly easier, than other majors on campus.


As this data is only a report of the students at one university, it is not generalizable to all colleges and universities. Also important to note, is that these students were in a Health Promotion program, which may differ in some ways from a Health Education (Teaching) or an undergraduate Public Health program. However, it is not difficult to imagine that students choosing similar majors at other universities may hold similar views. Assuming this is true, a number of recommendations can be made based on these findings for Health Promotion faculty to improve both the visibility of their departments on campus as well as strengthen their ability to recruit new students.

The first lesson is that due to students' strong gravitation toward "making a difference" and belief in "health promotion being important in today's society", it is essential that any marketing tools reflect this message. In an open-ended portion of the questionnaire, many students voiced a need for the major to be publicized, as it is a "found" major. This may be feasible via on-campus mailings, targeted e-mails, announcements on electronic student billboards, posters around campus, or informational booths during freshman and transfer orientation. To appeal to potential students, these themes must be emphasized. One strategy may be to use quotes such as Margaret Mead's "Never doubt that a small group of thoughtful, concerned citizens can change the world. Indeed it is the only thing that ever has."

The findings regarding Krumboltz's typology suggest that students' first-hand experiences are more important that either their impressions from those currently working in the field or the influence of the significant others around them. They could also be interpreted to mean that students value their current experiences (such as enjoying their coursework) more than they value their future experiences (such as the belief that their future job satisfaction will be high).

Another lesson is that it is imperative that ties to high schools be strengthened, as students report early interest in health-related careers, but few receive information from high school counselors or health teachers about careers in Health Promotion. Informational packets on the Health Promotion major could be mailed to school counselors and high school health teachers. Faculty could also visit high school career days to provide exposure to students unfamiliar with the field of Health Promotion. It would also be helpful to use required college-level Personal Health courses as a platform for informing students about careers in Health Promotion and the availability of the Health Promotion major. Health-related Liberal Arts core coursework may also attract new students, as many students indicated they switched to the major after taking a health-related course as a university elective.

In today's technology-based society, maintenance of an informative website is essential, as it was identified as one of the students' major source of discovery. It may be especially important to highlight information regarding future job possibilities in Health Promotion as many students cited a lack of knowledge of potential jobs as a barrier for new students to join the major.

Continued ties to Academic Advising are important as their office is a strong source of discovery. It may be helpful for faculty to periodically meet with Academic Advising to update them on changes to the major and new learning opportunities in order to keep Health Promotion fresh in their minds. Also, attempts should be made to inform students of the Health Promotion major during freshman and transfer orientation. This may be accomplished through an informational booth, flyer, or faculty presenter. It may also be possible for the major to be featured in the university materials by contacting the Public Relations department with unique features or programs within the department that could be highlighted.

Important to note, although this questionnaire did not specifically address high quality teaching, previous research in the Accounting field has indicated that high quality teaching in an introductory course can influence students' choice of major (Mauldin, Crain & Mounce, 2000). Thus, departments should place great consideration on the choice of faculty for introductory coursework as it may influence student recruitment over time.

Finally, while these findings only reflect the students at one university, this research can now be expanded to larger groups of Health Promotion students across the country, as well as comparing Health Promotion students to students with other majors.


While recruitment to the university campus is highly understood as essential to the livelihood of the university, discussion of recruitment to specific majors is rarely discussed. This many change over time if, as projected, many states see declining numbers of students enrolled in high schools, and thus, declining numbers enrolling in college. Recruitment many then become necessary in order to prevent declines in majors enrollments. Based on these findings the following applications can be made to Health Promotion faculty looking to increase enrollment in programs: 1) target students who have a desire to "make a difference in the world", 2) strengthen ties to high school counselors and teachers, 3) maintain high quality websites with information on career paths in Health Promotion, 4) forge and maintain strong ties with the Academic Advising Office, and 5) use required and elective health courses as opportunities to introduce students to careers in Health Promotion. Building good Health Promotion departments and recruiting high quality students into them is essential in today's world where health workers are in increasing demand and face great challenges to improve the health of their communities and the world at large.


The authors would like to thank Mr. David Marchesani, Academic Advisor, for his insight into the design of this instrument.


Bell, M.T. & Khodeli, I. (2004). Public Health Worker Shortages. Lexington, KY: Council of State Governments.

George, L., Wystrach, V.P., & Perkins, D. (1985). Why do students choose chemistry as a major? Journal of Chemical Education, 62(6), 501-502.

Holland, J.L. (1973). Making vocational choices: A theory of careers. Englewood Cliffs, NJ: Prentice Hall.

Holland, J.L. (1985). Making vocational choices: A theory of vocational personalities and work environments (2nd ed.). Englewood Cliffs, NJ: Prentice Hall.

Kroc, R., Howard, R., Hull, P., & Woodward, D. (1997). Graduation rates: Do students' academic program choices make a difference? Annual Forum of the Association for Institutional Research.

Krumboltz, J.D. (1979). A social learning theory of career decision making. In A.M. Mitchell, G.B. Jones & J.D. Krumboltz (eds.), Social learning and career decision making (pp. 19-49). Cranston, RI: Carroll Press.

Maudlin, S., Crain, J.L., & Mounce, P.H. (2000). The Accounting Principles instructor's influence on students' decision to major in Accounting. Journal of Education for Business (Jan/Feb), 142-148.

Minor, C.W. (1992). Career development theories and models. In D.H. Montross & C.J. Shrinkman (eds.), Career development: Theory and practice (pp.7-34). Springfield, IL: Charles C Thomas Publisher.

National Center for Educational Statistics. (2006). Projections of educational statistics to 2015 (34th ed.). Washington DC: U.S. Department of Education.

Parsons, F. (1909). Choosing a vocation. Boston: Houghton Mifflin.

Psychological Assessment Resources. (n.d.). The Self-Directed Search Website. Retrieved October 1, 2007 from the World Wide Web: http://www.self-directed-search.com/aboutsds.html

Strasser, S.E., Ozgur, C., & Schroeder, D.L. (2002). Selecting a Business college major: An analysis of criteria and choice using the analytical hierarchy process. Mid-American Journal of Business, 17(2), 47-56.

Super, D.E. (1953). A theory of vocational development. American Psychologist, 8, 185-190.

Super, D.E. (1990). Career and life development. In D. Brown & L. Brooks (eds), Career choice and development (2nd ed., pp. 197-261). San Francisco: Jossey-Bass.

Susan Roberts-Dobie, PhD, is affiliated with Division of Health Promotion and Education, University of Northern Iowa. Lindsey Sirowy, BA, is affiliated with University of Iowa. Please address all correspondence to Dr. Susan Roberts-Dobie, Division of Health Promotion and Education, 219 Wellness and Recreation Center University of Northern Iowa Cedar Falls, Iowa 50614-0241. PHONE: 319-273-5930, FAX: 319.273.5958, E-mail: susan.dobie@uni.edu.
Table 1. Strength of Influences on Choice of Health Promotion

How strong of influence were                 N     M      SD
the following in your decision
to major in Health Promotion?
(1 = not at all, 5 = extremely

Belief that Health Promotion is              80   4.54   .64
important in today's society
Desire to make difference in the             80   4.23   .81
world through career choice
Interest in the course content               79   4.10   .87
Belief that future job satisfaction          79   3.91   1.05
will be high
Participation in sports or physical          79   3.58   1.24
Belief that Health Promotion is an           78   3.35   1.22
alternative to other health related
professions (such as medicine or nursing)
Belief that Health Promotion is a            80   3.28   1.23
prestigious career option
Diversity of career opportunities            79   3.25   1.28
in the Health Promotion field
Desire to work in education, but             75   2.84   1.18
not be a school teacher
Desire to go to graduate school in           68   2.81   1.36
a related area
Job availability in the Health               79   2.75   1.29
Promotion field
Having a parent/relative/friend              71   2.61   1.37
encourage you to study Health Promotion
Having a parent/relative/friend              66   2.58   1.30
who worked in the health field
Academic Advising Office                     65   2.14   1.04
recommendation to study Health
Financial compensation related to            77   1.97   1.04
jobs in the Health Promotion field
Required Personal Health course              78   1.79   1.07
High school health teacher                   71   1.77   1.06
High school guidance counselor's             58   1.33   .83
recommendation to study Health Promotion

Table 2. Strength of Influence by Typology

Krumboltz Typology                          N     M        CL

Instrumental Learning Experiences           78   4.12   4.00-4.23
Belief that Health Promotion is
important in today's society
Desire to make difference in the
world through career choice
Interest in the course content
Participation in sports or
physical activity

Associative Learning                        76   3.50   3.30-3.70
Belief that future job
satisfaction will be high
Belief that Health Promotion is an
alternative to other health related
professions (such as medicine or nursing)
Belief that Health Promotion is
a prestigious career option
Diversity of career opportunities
in the Health Promotion field

Environmental Conditions                    48   2.05   1.84-2.26
Job availability in the Health
Promotion field
Having a parent/relative/friend
encourage you to study Health
Having a parent/relative/friend
who worked in the health field
Academic Advising Office recommendation
to study Health Promotion
Financial compensation related to jobs
in the Health Promotion field
High school health teacher
High school guidance counselor's
recommendation to study Health Promotion

Note: Three factors were not categorized as they did
not fit well into Krumboltz's typology :A

* Desire to work in education, but not be a school teacher

* Desire to go to graduate school in a related area

* Required Personal Health course
Gale Copyright: Copyright 2009 Gale, Cengage Learning. All rights reserved.