Easy as PIE: A Recipe for Approaching the Areas of Responsibility and Competencies for Health Education Specialists

Abstract

Experiential learning to address the Areas of Responsibility and Competencies for health education specialists is scarce or limited in scope in the pedagogy literature. The purpose of this article is to describe the process in which faculty applied a unique experiential learning approach wherein students were involved in planning, implementing, and evaluating (PIE) a health promotion program over the course of an academic year. The PIE approach allowed faculty to modify and revise course objectives to better align outcomes with the Areas of Responsibility and Competencies for health education specialists. This article provides an overview of the past 4 years using the PIE approach, a synopsis of the various steps faculty employed to use this model, and student perception of the approach as a learning tool.

Keywords

experiential learning health education specialists health education competencies

September 2020 marks 100 years since the first undergraduate health education program was offered in the United States (Jean, 1951). However, health education was not established as a viable career option until the 1940s (Creswell, 1981; National Commission for Health Education Credentialing, Inc. [NCHEC] & Society for Public Health Education [SOPHE], 2015). Nearly four decades later, the Seven Areas of Responsibility and associated Competencies common to all entry-level health education specialists were outlined, leading to the founding of the NCHEC in 1988 and the first certification exam for health education specialists in 1990 (NCHEC, 1996). The Framework for the health education model of professional practice was updated in 2015, which retained the Seven Areas of Responsibility with 36 competencies further classified into 258 subcompetencies (NCHEC & SOPHE, 2015).

These updates to competencies and exams, as well as achieving and maintaining nationally accredited programs for both entry- and advanced-level health education specialist certifications occurred through the efforts of the NCHEC, SOPHE, American Association for Health Education (AAHE), and partners such as the Council on Education for Public Health (CEPH; AAHE, NCHEC, & SOPHE, 1999; Gilmore, Olsen, Taub, & Connell, 2005; NCHEC & SOPHE, 2015; NCHEC, SOPHE, & AAHE, 2006, 2010). The focus on improving health education competencies and accreditation “has provided valuable order and continuity to the profession” (McKenzie et al., 2016, p. 294).

Despite this impressive progress, postsecondary health education research is scarce, especially in curricular and pedagogical innovation (Frenk et al., 2010) as well as student mastery of health education competencies (Figueroa, Birch, King, & Cottrell, 2015). This presents a challenge, as students preparing to become entry-level health education specialists must demonstrate competency in all Seven Areas of Responsibility including specific subcompetencies focused on entry-level proficiencies. Of the 258 subcompetencies, 141 of these are categorized as entry level (NCHEC & SOPHE, 2015).

One area prevalent in the literature is the use of experiential learning as a pedagogical model aimed at immersing students in significant experiences so they may actively link and make sense of practice and theory (Kolb, 1984). Experiential learning has been defined in a variety of literature using words such as evidence-based, active engagement, direct encounters, and hands-on learning (Phipps, Osborne, Dyer, & Ball, 2008; Sweitzer & King, 2014). Experiential learning incorporates a variety of innovative curricular strategies (e.g., internships, field experiences, service-learning and volunteer projects, study abroad experiences, community-based participatory research, and in-class tasks) promoting active learning for students to practice skills and translate classroom knowledge into real-life settings (Breunig, 2017; Gambescia, 2016). Through the integration of experiential learning across multiple academic disciplines, a number of positive outcomes have resulted, such as improvements in student learning, professional development, and collaborative relationships between colleges and community organizations (Beard & Wilson, 2013).

While the evidence of this teaching strategy promotes benefits, experiential learning activities are a rarity in upper-division postsecondary courses across disciplines (Faculty Survey of Student Engagement [FSSE], 2017). Notably, among 10 different academic areas, more than 42% of faculty reported they did not incorporate experiential learning activities in their courses. When considering health professions, human services professions, and social sciences, 29%, 49%, and 58% of faculty members, respectively, did not devote any of their course time to experiential learning (FSSE, 2017). Perhaps these numbers represent the additional time and energy required to devote to the challenging tasks of planning, implementing, and evaluating experiential learning activities (Gambescia, 2016). These tasks necessitate the need for faculty to embrace and integrate diverse teaching methods, particularly those which incorporate action and translational learning (Glanz, 2017).

Although limited, research has been conducted on experiential learning activities as they relate to health education competencies. For instance, Geiger and Werner (2004) found that through the incorporation of a service-learning project, undergraduate elementary education students were able to successfully address health education competencies in Areas II, III, and IV. Although this study illustrated several benefits related to attaining competencies, the sample size was small and noted as a limitation.

Champagne (2006) also evaluated multiple service-learning projects addressing health education skill and competency development. Although the sample size was also small (n = 12), the design and structure of these specific learning projects allowed undergraduate students to apply knowledge, practice in community settings, and evaluate their experience, particularly reporting perception of skill and competency development. While results varied according to the type of service-learning project implemented and specific community site, results illustrated the effectiveness of conducting an evaluation, especially when using these projects as pedagogical approaches for enhancing skill and competency development.

Bentley and Swan (2017) also explored experiential learning addressing health education competencies via a grant writing course for undergraduate community health students. Partnering with stakeholders from local community-based organizations, student teams addressed key public health needs of the organization by writing and submitting grant proposals. The health education competencies addressed in the course included Areas I, II, and V, and consisted of tasks such as performing a comprehensive needs assessment, planning health promotion programs, and administration and management of health promotion programs.

Similar to previous literature presenting experiential learning as a means to address health education competencies, the purpose of this article is to describe the process in which faculty at a Midwestern Regional University in the United States adopted the PIE (planning, implementation, and evaluation) approach as a pedagogical approach. This allowed faculty to align health education curriculum with the Areas of Responsibility for health education specialists. This article provides an overview of the PIE approach as a means for students to apply classroom learnings to practical settings.

Learner Activity

The information presented in this article delineates a pedagogical approach specifically addressing the Areas of Responsibility defining the role of a health education specialist (NCHEC & SOPHE, 2015). Faculty labeled this approach as the PIE assignment to reflect that undergraduate students must “Plan, Implement, and Evaluate” a health promotion program. This cumulative assignment is required of seniors completing a Bachelor of Health Sciences with a focus on health education. This degree includes, but is not limited to, courses in anatomy, physiology, epidemiology, biostatistics, health education, research methods, health promotion planning and evaluation, communicable and chronic diseases, and health behavior theory. The degree program prepares students to take the Certified Health Education Specialist exam on graduation.

PIE approach assignments occur during three core courses over two semesters. Students remain in a cohort for these courses to ensure student groups remain the same throughout PIE. The assignment requires students to (a) write a health promotion grant; (b) submit an institutional review board (IRB) application (new in 2017); (c) plan, implement, and evaluate the health promotion program; and (d) design and present a poster presentation based on the program outcomes. Funding for these programs initially came from the university’s Office of Student Health Promotion program with a specific focus on collegiate students’ health issues. After 3 years, funding continued with the support of the dean’s office and the university provost’s office.

Future funding is slated to come from the university’s Center for Community Engagement, with the stipulation that the health promotion programs be conducted in and for the community. This focus on community issues supports university mandates on experiential learning and community engagement by allowing students to interact with populations outside the boundaries of the university. Students will have the opportunity to conduct needs assessments for specific populations versus concentrating solely on students while also exposing students to socioecological factors (e.g., demographics, social and cultural norms) affecting healthy choices.

Groups of approximately 5 to 7 students are established during the initial health promotion planning course. Each student group chooses a health topic and writes a grant proposal with the total budget not exceeding $500 for program development. Per semester, there are approximately 6 to 8 groups of students applying for a $500 grant ($3-$4,000). Funding is competitive; the grant must be well-developed with measurable outcomes. Since funding is not a “given” and an alternate assignment is given to those not funded helps encourage the students to develop a solid grant proposal. For example, students in groups not funded must individually develop and teach a 75-minute health education lesson for a class of 40 college freshmen. Individually developing and teaching a course versus implementing a program as a group appears to provide necessary motivation for students to write a competitive grant.

Students present their grant program proposal as their final exam to all faculty (typically 4-5) teaching required courses involved with the cumulative assignment. Once the students complete their grant proposal presentation in the initial semester, faculty provide feedback on methodology, survey, statistical analysis, and outcomes. Using feedback, students revise their original grant and submit to the funding committee.

During the second semester of the assignment, students implement and evaluate the program during concurrent enrollment in two courses: health promotion evaluation and senior seminar. The health promotion program and poster presentation are conducted in senior seminar as a cumulative event, with the health program evaluation conducted in (and simultaneously used for the poster results) in the health evaluation course.

Campus Involvement: Students, Faculty, and Staff

From 2013 to 2016, poster presentations were submitted to an intramural conference, allowing students to present their research to faculty, staff, and students. For the 2017-2018 academic year, students were required to write and submit an IRB application prior to implementing their health promotion program. Student groups also submitted an abstract to the 2018 National Conference on Undergraduate Research with six of the seven groups accepted for presentation.

Areas of Responsibility for a Health Education Specialist

Although the initial PIE assignment was developed to meet university mandates on inclusion of experiential learning, faculty noticed during the program evaluation that components aligned specifically to Areas of Responsibility outlined in the 2010 Framework and subsequently maintained in the revised 2015 Framework (see Figure 1; NCHEC & SOPHE, 2015; NCHEC, SOPHE, & AAHE, 2010). This proved extremely helpful and allowed faculty to revise, add, and further develop the PIE assignment each year to align with health education competencies and Areas of Responsibility in the prevailing Framework (NCHEC & SOPHE, 2015; NCHEC, SOPHE, & AAHE, 2010).

Figure 1.

Assignments and approximate effort spent within responsibilities.

Results: Planning

Although students were free to choose their own health program topic, seven categories of topics emerged over the 4-year period: addiction (alcohol, drugs), cold/flu, health education, nutrition, physical activity, sexual awareness, and stress. Of the seven categories, health education and nutrition topics were the favorite topics (duplicate topics within a specific cohort were not allowed; students chose another topic if their initial choice was already taken).

Figure 1 provides an overview of the specific assignments students completed within each Area of Responsibility and a visual representation of approximately how much effort students spent in each area. (These are estimates based on faculty input.) Results from these assignments allowed faculty to use student participation and outcomes to refine course objectives; identify gaps in student knowledge, skills, and abilities (especially in areas of career readiness skills); and increase the interaction between faculty concerning course assignments. Each were identified based on student challenges, barriers, issues, and success during program implementation. These results were discussed during faculty program meetings allowing interaction between faculty as well as adjustments to existing syllabi to include or remove objectives related to students’ knowledge, skills, and abilities.

Results: Implementation

Student program implementation spanned approximately 6 weeks. Faculty and administrative staff were involved in this process as implementation required administrative and logistical skills that many students had not experienced. Table 1 provides an overview of information provided to students prior to implementation. Close work with the department administrator ensured students were on track and processing required paperwork for logistics (e.g., purchasing budgeted items) as needed.

Table 1.

Planning the Health Promotion Program.

Do	Do not
Make sure you have a written plan that details what your project objective is. This plan should also include a detailed budget that lists ALL expenses (food, giveaways, printing, etc.) and utilizes your grant money appropriately.	Pay for purchases with your personal money. All purchases MUST be paid using departmental accounts.
Plan in advance for your project. Make an appointment with the administrative person to go over your project plan and budget with as much notice as possible. This will ensure that your items are ordered and arrive in plenty of time.	Come to my office the day before your promotion asking to order items. We do not use Amazon Prime, or overnight shipping. You must plan ahead.
Work together as a group. Decide how you want to split the responsibilities of your project, and make sure you coordinate with each other. You can also have one person who makes all of the purchases, but that person should be responsible for keeping everyone informed.	Go over budget without authorization. If you have an issue, submit a budget revision prior to spending funds, which can be presented to the department chair. A justification for additional funds must accompany the budget request and include a solid rationale for more funds.
Have a detailed list of all items that you need to order. Make sure that you list the purchase place, item number, name of item, and quantity needed. If an item needs to be personalized (e.g., name of your promotion on a mug), this MUST be approved through the university, regardless if the logo is used or not.	Plan a budget that requires you to pay for most expenses out of pocket. Most students do not have the extra cash and cannot wait to be reimbursed by the department. DO plan your purchases with the Administrative Assistant to save money.
Reserve meeting spaces as soon as possible. Space on campus books very quickly.
Turn in ALL receipts immediately! If you must purchase items on your own, please put your name, address, and project name on the receipt. Remember, the university is a tax-exempt organization and DOES NOT reimburse for sales tax. Request a Sales Tax Exempt Form if you are purchasing items on your own.
If you purchase gift cards for a giveaway, a Distribution of Prizes and Awards form must be submitted, along with a Hospitality Form.
Respond to emails when your items are ready to be picked up. Prompt pickup of your items are appreciated in order to make room for other orders.

Since the coursework for the health sciences degree focuses on health education and public health content courses, this portion of the program came easily to students (e.g., preventive measures for diabetes). On the other hand, organizational and administrative skills presented challenges to students. Instances of struggles included poor planning for delivery of items (without resorting to overnight delivery charges); not checking orders to ensure all ordered materials were delivered; budgetary constraints while choosing and shopping for grocery items; adhering to university logo usage requirements; and ordering items from overseas’ locations and experiencing problems with delivery dates. Other challenges encountered during implementation included working with group members to schedule and organize the event and ensuring all group members participated in the final program.

Assignments within the PIE approach helped students learn about basic program elements such as determining incentives, including taxes on ordered items in final budgets, and scheduling logistics. Ultimately, students overcame obstacles and learned critical organization, administrative, and professional skills not previously addressed in course assignments.

From 2013 to 2017, 247 students completed the PIE assignment to deliver 45 health promotion programs. Final data collected on 22 of the programs resulted in 1,569 total participants in those 22 programs. Incomplete data (i.e., total participants, pre- and posttests) from remaining programs (n = 23) was not complete, as program implementation was not finished prior to poster drafts and only anticipated data were available. It is estimated that all health promotion programs in total reached approximately 3,000 participants. Total funding from 2013 to 2017 was $22,300.

Results: Evaluation

Although students evaluated outcomes of each program, it is beyond the scope of this article to discuss all program outcomes. To better understand the results and impact of the PIE approach to learning, the authors of this article analyzed the final reflection submitted in the required 350-hour internship at the end of students’ senior year. As part of this reflection, students are asked to expound on their academic career using Ash and Clayton’s DEAL (Describe, Examine, Articulate Learning) model of reflection (Ash & Clayton, 2009). One question specifically asks students to reflect and examine their academic learning by considering the following question: “What specific academic material (from your education) did you find relevant to this experience?” A second question asks students to again reflect by answering the question, “What academic skills did I use during the internship?

From 2013 to 2017, 170 student reflections were obtained. An analysis of answers to the first question (specific academic materials) showed 63 students (37%) named the health promotion planning and evaluation courses as pertinent to their internship experience. Other courses mentioned often were Health Education Methods (n = 26, 15%) and Senior Seminar (n = 41, 24%). It is important to note that Senior Seminar is where students actually implement the health promotion program. Table 2 further lists specific quotes made by students during their internship relevant to the PIE approach.

Table 2.

Health Education Students’ Quotes From Internship Reflection.

I learned the importance of evaluation for any program, especially the importance of including your key stakeholders and your target audience.

The responsibilities and duties I was engaged in including grant writing, health program evaluation, and education all made me feel like I was a professional in the health sciences field.

I walked away with the realization that we are not necessarily there to change individuals’ lifestyles but to inform them and provide them with the resources necessary for them to make informed decisions.

The projects that were required were by far the greatest learning experiences. I was able to apply things learned from program planning, grant writing, program evaluation and biostatistics. For me personally, this aided in my learning experience.

I also learned that you will act as a health coach, a resource person, and everything else in one when you enter the job force.

My project for my internship was to create a diabetes program at the hospital that included a comprehensive education section as well as developing a week-long health fair for the members of the community; I was continuously using information and skills from Health Promotion Planning, Health Programs Evaluation and Communicable and Chronic Diseases courses.

My academic skills prepared me for my internship at Wellness for Life; gaining knowledge on writing grants was very beneficial to my internship. Grant writing and the program we implemented showed me how to work with others, planning, organization, and research.

The concept of professional development and growth that I gained from the health program planning and evaluation course were useful in the sense that I was able to discuss operations with outside agencies and professionals.

Planning a health program from start to finish (materials needed, budget, venue, food, etc.) was very helpful when it came time to planning and implementing the Prime Time Expo. It also came into play when it came to the actual day of the event as far as show casing the agency, as well as evaluating the turnout of the event.

My health promotions planning class was very helpful. Although I did not exactly plan a health promotion event, planning a conference was very similar as I had to take many of the same steps and they built off each other.

AHS 418 really taught me about Health Promotion. It taught me that numerous other people behind the scenes are involved with programs that I needed to be aware of when creating a program of any kind.

In my AHS 414 course, I learned how to develop and strategically implement a program on campus with other students in my major. From this opportunity, I was able to gain experience and think of effective ways to put on health programs for a particular population. Also, understanding and learning about the importance of developing goals and objectives for programs is something valuable I learned from the course. Goals and objectives are essential in order to make sure whatever desired need is met. With program planning experience it has allowed me to fully evaluate and examine the progress of the program and make alterations in order to make it the best it can be.

I was able to properly take responsibility and feel comfortable with my project now that I have done projects and presentations throughout my college career, but what especially prepared me for my project was my grant. Having a yearlong project really prepared me for having the accelerated project while making sure to include important information.

Analysis of the second question (what academic skills were used) was undertaken to review whether students mentioned competencies outlined in the health education Frameworks (NCHEC & SOPHE, 2015; NCHEC, SOPHE, & AAHE, 2010). Table 3 lists the seven areas of responsibility and the 36 competencies outlined in the 2015 Framework for health education specialists. As the table shows, students used competencies acquired during their education in the various internships. Although further categorizing the table into the 258 subcompetencies was beyond the scope of this article, students mentioned performing tasks and responsibilities aligned with the 36 competencies listed, indicating the importance of the learned skills in their internship assignment.

Table 3.

Academic Learning Mentioned by Students During the Final Internship That Addresses Health Education Competencies.

	Health Education Specialist Practice Analysis 2015 Model: Areas of Responsibility and Competencies (NCHEC & SOPHE, 2015)	Number of times mentioned
	Area of Responsibility I: Assess Needs, Resources, and Capacity for Health Education/Promotion
1.1	Plan assessment process for health education/promotion	6
1.2	Access existing information and data related to health	11
1.3	Collect primary data to determine needs	15
1.4	Analyze relationships among behavioral, environmental, and other factors that influence health	6
1.5	Examine factors that influence the process by which people learn	8
1.6	Examine factors that enhance or impede the process of health education/promotion	5
1.7	Determine needs for health education/promotion based on assessment findings	16
	Area of Responsibility II: Plan Health Education/Promotion
2.1	Involve priority populations, partners, and other stakeholders in the planning process	10
2.2	Develop goals and objectives	23
2.3	Select or design strategies/interventions	4
2.4	Develop a plan for the delivery of health education/promotion	24
2.5	Address factors that influence implementation of health education/promotion	4
	Area of Responsibility III: Implement Health Education/Promotion
3.1	Coordinate logistics necessary to implement plan	6
3.2	Train staff members and volunteers involved in implementation of health education/promotion	2
3.3	Implement health education/promotion plan	16
3.4	Monitor implementation of health education/promotion	12
	Area of Responsibility IV: Conduct Evaluation and Research Related to Health Education/Promotion
4.1	Develop evaluation plan for health education/promotion	14
4.2	Develop a research plan for health education/promotion	7
4.3	Select, adapt, and/or create instruments to collect data	1
4.4	Collect and manage data	12
4.5	Analyze data	7
4.6	Interpret results	8
4.7	Apply findings	2
	Area of Responsibility V: Administer and Manage Health Education/Promotion
5.1	Manage financial resources for health education/promotion programs	3
5.2	Manage technology resources	0
5.3	Manage relationships with partners and other stakeholders	1
5.4	Gain acceptance and support for health education/promotion programs	2
5.5	Demonstrate leadership	13
5.6	Manage human resources for health education/promotion programs	2
	Area of Responsibility VI: Serve as a Health Education/Promotion Resource Person
6.1	Obtain and disseminate health-related information	8
6.2	Train others to use health education/promotion skills	4
6.3	Provide advice and consultation on health education/promotion issues	4
	Area of Responsibility VII: Communicate, Promote, and Advocate for Health, Health Education/Promotion, and the Profession
7.1	Identify, develop, and deliver messages using a variety of communication strategies, methods, and techniques	5
7.2	Engage in advocacy for health and health education/promotion	4
7.3	Influence policy and/or systems change to promote health and health education	1
7.4	Promote the health education profession	10

Interestingly, the competencies mentioned less frequently, or not at all (i.e., Area IV, Competency 5.2 [Manage Technology Resources]), were often those identified in the 2015 Framework as advanced-level subcompetencies. For example, Area III, Competency 3.2 (Train Staff Members and Volunteers in Implementation of Health Education/Promotion) garnered only two mentions, as did Area IV, Competency 4.3 (Select, Adapt, and/or Create Instruments to Collect Data; n = 1), and Area V, Competencies 5.1 and 5.3 (Manage Financial Resources; Manage Technology Resources; n = 4). The lack of mention by undergraduate students completing an internship appears to support the focus on these competencies as advanced.

Of those competencies mentioned frequently, Area II, Competency 2.2 (Develop Goals and Objectives), was mentioned by 23 students, while Area II, Competency 2.4 (Develop a Plan for the Delivery of Health Education/Promotion), was mentioned 24 times. Again, although this represents only 13% to 14% of the students, it is indicative of the competencies addressed by students. Other competencies mentioned related to needs assessments, accessing data, implementing and monitoring health programs, and data collection and/or evaluation.

Discussion

Initially, the goal of the assignments within the PIE approach was to better structure health sciences curriculum to align with university experiential learning mandates as well as emphasizing community engagement. As the approach continued to evolve, it achieved the initial goal. It also began to expand. The realization was that the PIE approach addressed many of the health education competencies and Areas of Responsibility (NCHEC & SOPHE, 2015). This approach offered students the opportunity to use their coursework to improve critical skills and competencies required in the workforce. The PIE approach, spanning a full academic year, was the one assignment students repeatedly mentioned when submitting a final reflection after their internship. Students referred to the opportunity to write a grant, plan, implement, and evaluate a health program, and present the research, as one of the best learning opportunities they experienced. Table 2 is further testimony to the narrative students submitted on learning. Although this is only a portion of the comments, the table shows student insight on the perceived value experienced by participating in the year-long approach.

Conclusion

The assignments integrated into the PIE approach evolved and improved over 4 years with positive reports on student learning. Through the various assignments within the PIE approach, students engaged in experiential experiences, allowing them to draw on course content and apply these skills during their internship. In addition, using the PIE approach addressed the Areas of Responsibility and health education competencies initially defined in the 2010 Framework and later revised in the 2015 Framework established by NCHEC and SOPHE. Based on student feedback, the PIE approach appears to be a useful pedagogical tool for immersing students in experiential learning that ultimately addresses health education competencies and Areas of Responsibility.

Footnotes

Authors’ Note

Kathryn Berlin is now at Indiana University, IUPUI, Indianapolis.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Kathryn Berlin

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