Abstract
The knowledge of genomic discoveries has been expanding daily, holding enormous potential to improve population health. Nevertheless, the training of health educators about genomics is lagging behind. To facilitate the movement of genomics into health promotion practice, as the first step, we conducted the first national survey to examine genomic education needs among health educators in the United States. A total of 980 health educators holding the Certified Health Education Specialist designation completed our web-based survey. The majority of participants reported that they had limited knowledge and training in genomics and were interested in seeking genomic education. Their first three preferred educational topics included genomic disorders/diseases (68.2%), family health history or genetic risk assessments (55.5%), and how to link genomics to health promotion (51.0%). A few contents, including basic genomic concepts, communication skills, and how to integrate genomics into routine professional tasks, were important to health educators’ practice in genomics, but respondents seemed to be less favorable toward learning these contents. Continuing education (89.4%), web-based training (85.9%), and professional conferences (76.7%) were participants’ top three desired delivery methods. This study will help guide the development, implementation, and evaluation of future genomic training programs for U.S. health educators.
Introduction
Although the knowledge of genomic discoveries has been expanding daily, the training of public health professionals about genomics is lagging behind (Secretary’s Advisory Committee on Genetics, Health, and Society [SACGHS], U.S. Department of Health and Human Services, 2011). Currently, only a few genomic education programs targeting public health professionals are available. The most well-known programs might be the 45-minute introductory presentation “E-Fact Sheet: Quick Facts About Public Health Genomics” (Centers for Disease Control and Prevention [CDC], 2010) and a web-based course, “Six Weeks to Genomic Awareness” (Michigan Public Health Training Center, 2012), sponsored by the CDC. The Association of Schools of Public Health (2003) also includes a module called “Public Health Genetics: Screening Programs and Individual Testing/Counseling” in its Ethics and Public Health curriculum.
To address the importance of genomic training for public health professionals, the SACGHS, U.S. Department of Health and Human Services (2011) released a genetic education and training report in 2011. In that report, the committee acknowledged several challenges in developing a genomically competent public health workforce. These challenges included (1) the diverse training, background, and practice of public health professionals; (2) the lack of formal training in genomics at schools; and (3) the inadequate genomic knowledge and negative attitudes toward acceptance and adoption of genomics into practice among the public health community. Because of these unique identified obstacles, the SACGHS, U.S. Department of Health and Human Services (2011) concluded that providing one-size-fits-all genomic education to the entire public health workforce is unfeasible. Conversely, carefully planned genomic training programs targeting each specific public health workforce group are essential.
As a part of public health workforce, health educators face similar barriers, recognized by the SACHGS, in becoming genomically competent (SACGHS, Department of Health and Human Service, 2011). Although the curricula of health education programs vary, most do not require or include genomics (National Commission for Health Education Credentialing, Inc. [NCHEC], 2012). Moreover, health educators have a genomic knowledge deficit (Chen & Goodson, 2007, 2009). A national survey conducted by Chen and Goodson (2007) showed that less than 30% of the U.S. health educators answered the questions regarding the Human Genome Project, genetic testing, and the calculation of the genetic risks correctly. Along with the insufficient genomic knowledge, this professional group also demonstrated a low willingness to incorporate genomics into public health. Less than 35% health educators were very likely or likely to adopt the CDC’s proposed genomic competencies into their work settings (Chen, Kwok, & Goodson, 2008).
Given that health educators are not ready to adopt genomics into their practice, an effective genomic training and education program should start at needs assessment among this particular group. Needs assessment can clarify the goals and learning objectives of a genomics training program and help develop related strategies for implementing and evaluating the program (Metcalfe, Aitken, & Gaff, 2008; Moore, 1984). As there are enormous competitive continuing education opportunities for health educators, needs assessment can facilitate the development of more attractive educational programs for health educators to study genomics—a relatively new and unfamiliar topic—than perhaps other more acquainted health areas, such as drugs, sexuality, nutrition, and physical activity.
Chen and Goodson (2013) conducted a qualitative study to assess genomic education training needs among 24 health educators in the United States. They found that the majority of the sample desired to receive genomic training, even though they had limited or no training in this area. Participants also indentified their preferred topics and delivery avenues in genomic training. Although the findings of that qualitative study shed some light on health educators’ needs in genomic education, a quantitative study is needed to provide more rigorous data in this area. Therefore, to the best of our knowledge, the purpose of this study is to conduct the first national survey to examine genomic training and education needs among U.S. health educators.
Method
Participants
We targeted our sample to health educators holding the Certified Health Education Specialist (CHES) designation. Provided by the NCHEC, Inc., CHES is the certification for health educators in the United States. To maintain this certification, health educators holding the CHES designation must take a minimum of 75 Continuing Education contact hours every 5 years (NCHEC, 2012). To keep up with the practice/study in the public health field, certified health educators tend to be interested in learning new information. Given that genomics is new and seldom taught in schools, health educators with an active CHES certification are the target audience for receiving continuing education in genomics. Selecting this group for this needs assessment study, therefore, would contribute to the successful development of future continuing genomic education programs tailored to their wants and needs.
We purchased a CHES list from the NCHEC. The list consisted of 7,978 health educators with an active CHES certification status. Removing the ones without valid e-mail addresses, we had a total of 7,876 potential participants.
Instruments
Based on relevant literature (Acton et al., 2000; Cragun, Couch, Prows, Warren, & Christianson, 2005) and a qualitative study conducted by Chen and Goodson (2013), we developed a survey assessing the genomic education training needs among heath educators. The survey was then deployed using an online survey software tool—Qualtrics (http://www.qualtrics.com/). To validate our survey instrument, we conducted cognitive interviews with four health educators, as well as retrospective interviews with 10 health educators. Six experts in genetics, health promotion, and public health genomics also evaluated the content of the survey. Later, we randomly selected 250 health educators from the CHES list to pilot test our study. According to the pilot test data with 26 participants, the survey was revised and further reviewed by an expert in public health genomics. Moreover, six health educators were cognitively interviewed to validate the revised survey.
The final version of the questionnaire included items regarding (1) previous training and education in genomics, (2) self-reported genomic knowledge, (3) beliefs and values of incorporating genomics into health promotion practice, (4) perceived need for training and education in genomics, (5) desired genomic training and education topics, and (6) preferred delivery methods for training and education in genomics. We also collected participants’ demographic information, including age, gender, ethnicity, religious preference, and educational level. The number of years of graduation, practice, and having a CHES certification, as well as the state of practice in health education, were also gathered.
Procedures
We obtained the approval of the institutional review board at Texas A&M University for all study procedures. Excluding the contact list used in the pilot test (n = 250), we invited 7,626 health educators holding the CHES designation to take part in this study. All potential participants received one formal invitation and two follow-up e-mails with a unique electronic hyperlink to access our web-based survey. The completion time of the survey was approximately 10 minutes. A total of 980 health educators filled out our survey, yielding a response rate of 12.9%. After the completion of the survey, all participants were provided links to access genomic educational resources and materials. Additionally, participants could enter a drawing for ten $10 gift cards.
Statistical Analysis
We employed the IBM SPSS Statistics Version 20.0 (IBM SPSS Inc., Chicago, IL) for data analyses. After including data in the pilot test and excluding incomplete responses in the formal test, a total of 835 responses were included in the final data analysis. We performed descriptive statistics on all measured variables. Moreover, participants who answered “probably yes” or “definitely yes” for them to receive training in genomics were classified as a desired training group (n = 730), whereas the rest, who answered “probably not” or “definitely not,” were labeled as an undesired training group (n = 86). We used χ2 tests and Student t tests to compare the differences in characteristics between these two groups.
Results
Sample Characteristics
Most participating health educators in this study were Whites (75.0%) and females (88.4%), with an average age of 40.6 years (SD = 12.2, range = 22-84 years). More than half (63.0%) of them had obtained a master’s degree in the health education/promotion field and 13.7% had a doctoral degree. A total of 318 respondents (41.0%) practiced in the South of the United States and one fifth in the West (21.2%) or Midwest (20.1%). Participants’ average years of practicing were 11.8 ± 9.0 years (range = 0-50 years). In terms of religion, respondents identified themselves as non-Catholic Christians (48.8%), Catholics (24.1%), Jews (3.8%), no religion (18.6%), and others (4.7%).
Genomic Knowledge and Beliefs/Values of Incorporating Genomics Into Health Promotion Practice
On a 5-point Likert-type scale, we asked health educators to self-report their genomic knowledge. Most participants admitted that they had no or very little knowledge in this area (60.6%). Only 5.6% claimed that they had quite a lot or an extensive amount of knowledge in genomics.
Furthermore, the majority of participants (94.1%) agreed or strongly agreed that genomics should be incorporated into their practice. However, when asking the importance of integrating genomics into their practice, merely 71.1% stated that this is somewhat or extremely important.
Previous Training and Perceived Needs in Genomic Education
The majority of respondents reported that they had no (47.7%) or very little (33.7%) training and education in genomics. Only few (3.4%) stated that they had quite a bit or an extensive amount of training in genomics. The five most frequently identified sources from where respondents received training were coursework, self-study, professional conferences/workshops, Internet, and interpersonal communication (e.g., discussing genomics with their colleagues and experts).
We used a 4-point Likert-type scale (i.e., definitely not, probably not, probably yes, definitely yes) to examine participants’ perceived needs for genomics training. The majority answered either probably yes (45.3%) or definitely yes (38.5%) to receive such training.
Desired Genomic Education and Training Topics
Respondents who would be interested in receiving genomic education (i.e., the desired training group) were asked to rate their desired training topics. As seen in Figure 1, their preferences, from the highest to the lowest frequency, were (1) genomic disorders/diseases (e.g., cancer, diabetes, cardiovascular diseases, and other chronic diseases; 68.2%); (2) family health history and genetic risk assessments (55.5%); (3) the link between genomics and health promotion (51.0%); (4) current and future developments in genomics (49.8%); (5) the ethical, legal, and social implications of genomics (48.8%); (6) genetic testing/screening (48.6%); (7) genetic disorders/diseases (e.g., cystic fibrosis, hemophilia, and sickle-cell anemia; 46.8%); (8) the interpretation of the results of family health history and genetic risk assessments (45.5%); (9) the chronic effects of chemical and biological hazards on human genes (e.g., the potential outcomes from bioterrorism; 43.3%); (10) communication skills regarding genomic information (38.9%); (11) the techniques to identify clients and family members who may benefit from genomic education (37.7%); (12) the adoption of genomics into routine professional tasks (33.2%); (13) basic genomic concepts (32.5%); and (14) the economic aspects of conducting genomic research (28.7%).
Desired Genomic Education Topic Among Health Educators Who Would Be Interested in Receiving Genomic Training
Preferred Delivery Methods for Genomic Training and Education
Figure 2 shows the preferred delivery methods for genomic education and training among the desired training group. Their preferences, in descending order of frequency, were (1) continuing education (89.4%); (2) web-based training (85.9%); (3) professional conferences, workshops, and symposia (76.7%); (4) interpersonal communication (e.g., talking to colleagues who are experts in genomics; 74.9%); (5) peer-reviewed articles (63.8%); (6) in-service training (61.3%); and (7) teleconferences (59.6%).
Preferred Delivery Methods for Genomic Education Among Health Educators Who Would Be Interested in Receiving Genomic Training
Factors Associated With Willingness to Receive Genomic Training and Education
The characteristic differences regarding the willingness to receive genomic education between the desired and undesired training groups were examined. None of the demographic and work-related variables (i.e., age, gender, ethnicity, religion, education level, years of graduation and practice, and region of practice) were significantly different between these two groups. Nevertheless, compared with the undesired training group, the desired training group had better self-reported genomic knowledge (p = .002), more previous training and education in genomics (p < .001), and higher perceived beliefs (p < .001) and values (p < .001) regarding adopting genomics into health promotion.
Discussion
Although needs assessment for genomic education has been studied for a variety of health professionals, to the best of our knowledge, this present study is the first study that sought to survey genomic education needs among health educators. Our findings showed that participants overall reported that they had limited knowledge and training in genomics. One potential explanation is that public health genomic education opportunities are seldom provided at health education/promotion conferences. Health educators, therefore, may lack exposure to the area of public health genomics. Yet this finding is not limited to health educators only. Previous studies have also indicated that public health and health care professionals had inadequate genomic knowledge and education (SACGHS, Department of Health and Human Service, 2011; Scheuner, Sieverding, & Shekelle, 2008).
Moreover, similar to the previous qualitative study by Chen and Goodson (2013) interviewing 24 health educators, most respondents in our survey were interested in genomic training. As such, genomic training is timely and needed for health educators who had restricted knowledge but were in favor of such training. In particular, the findings from this needs assessment study hold great potential to design genomic education programs for health educators. Respondents’ preferred topics in genomic training were related to applied genomic knowledge. This is consistent with a genetic education needs assessment study for general practitioners conducted by Metcalfe, Hurworth, Newstead, and Robins (2002), which suggested that health professionals are interested in educational content that are useful and relevant to their practice. Specifically, themes emphasizing genomic disorders/diseases, family health history or genetic risk assessments, and the link between genetics/genomics and health promotion were perceived as most interesting areas. The delivery modes of continuing education, web-based training, and professional conferences, workshops, and symposia were thought to be the most desirable by participating health educators. These findings echoed the Public Health Functions Project report: In addition to the traditional face-to-face delivery mode, web-based technologies are strongly encouraged to be used in educational programs (U.S. Department of Health and Human Services, 1997). To attract health educators to receive genomic training, therefore, future educational programs should start with these desired training topics and delivery methods.
Notably, we observed a few topics that are important in public health practice in genomics, but respondents seemed to be less favorable toward learning these themes. For example, although basic genomic concepts and communication skills were the basis to prevent misguidance and miscommunication of genomic information to clients, less than 40% of our sample perceived training needs of these domains. Likewise, only 33.2% participants expressed interest in learning how to integrate genomics into routine professional tasks. Nevertheless, these topics were a key element to ensure the success of integrating genomics into health educators’ daily practice. This suggests that health educators might not know what they need to know in genomic-related health promotion practice. To ensure a development of genomically competent public health education workforce, albeit a few topics appeared to be less interesting to health educators, training for these essential areas should be addressed.
It is noteworthy that our study indicated that 94.1% of health educators believed that genomics should be incorporated into health promotion. Although more positive attitudes are desired, 71.1% agreed that it is important to adopt genomics into their work settings. These percentages were somewhat higher than the previous study conducted by Chen and Goodson (2007), which showed that 86.6% to 90.8% U.S. health educators agreed with the CDC-proposed genomic competencies and 45.5% to 52.3% valued the imperativeness to adopt it into their practice. A likely explanation is that health educators responding to our survey might already have postulated favorable attitudes toward genomics. Furthermore, our sample consisted of health educators holding the active CHES designation who would be more likely to learn new information emergent in the field. Last, genomics is a growing trend in public health (Chen, 2011; U.S. Department of Health and Human Services, 2012). Healthy People 2020 (U.S. department of Health and Human Services, 2012), for instance, includes genomics as a new topic and objective. As a result, respondents might postulate more positive attitudes toward genomics than the past study by Chen and Goodson (2007, 2010) conducted in 2006.
This study has three limitations. The low response rate (12.9%) is the main restriction, which limits the generalizability of our findings. Yet the low response rate is understandable. Particularly, the response rate of the web-based anonymous survey of U.S. health educators’ attitudes and knowledge about genomics in the previous study was 23.1% (Chen & Goodson, 2010). Given that participants in this study might be limited to those who were interested in genomic training and the survey responses were confidential (not anonymous), a lower response rate might be realistic. Furthermore, in comparison with the past study by Chen and Goodson (2010) offering drawing of $50 money orders, drawing of $10 gift cards in this study might have been a less attractive incentive to health educators. The other constraint is that our sample is biased. Health educators completing our survey might postulate more favorable attitudes toward genomics and/or genomic training than those who did not engage in this research. Finally, other researchers should consider the self-reported response bias of this study. For instance, the knowledge item was self-reported, which might be different if a test was conducted to assess participants’ knowledge.
Despite the above-mentioned limitations, this first-of-its-kind study attempts to take a glance at genomic education needs among health educators. Our data revealed that none of the demographic and work-related factors were associated with participants’ intention to receive genomic training. On the contrary, those having previous training, better knowledge, and more positive attitudes in genomics would be more likely to receive further genomic education. These results strongly support the needs and significance of genomic training for health educators.
Conclusions
Our study suggested that genomic education is timely, necessary, needed, and imperative for health educators in the United States. Although health educators in this study reported themselves to have limited genomic knowledge, the majority showed a great interest in receiving genomic education. Additionally, results of this study will help guide the development, implementation, and evaluation of future genomic training programs for health educators. Specifically, this study includes valuable data regarding preferred delivery approaches, namely, continuing education, web-based training, and professional conferences, workshops, and symposia. Evidence-based desired educational topics (i.e., genomic disorders/diseases, family health history or genetic risk assessments, and the link between genomics and health education and promotion) and key elements (e.g., basic genomic concepts, communication skills, and how to integrate genomics into routine professional tasks) also need to be addressed in future genomic educational programs.
Footnotes
Acknowledgements
We would like to thank Mr. Kwon Chan Jeon and Ms. Champa Joshi for their assistance in this study.
This research was funded from Dr. Lei-Shih Chen’s Summer Scholarship Development Grant from the University of North Florida as well as start-up fund from the Department of Health and Kinesiology at Texas A&M University.