Faculty Perceptions of Certifications in Health Education and Public Health: Implications for Professional Preparation

Abstract

Leaders in the fields of public health and health education/health promotion have been advocating for required credentialing for almost two decades. Recently, some have questioned whether increasing the number of certified professionals could help better differentiate properly trained health educators and public health professionals from others seeking to fill jobs in this professional area. The purpose of this article is to determine how the CHES/MCHES (Certified Health Education Specialist/Master Certified Health Education Specialist) and CPH (Certified in Public Health) credentials are regarded and promoted within the field of health education/health promotion. A cross-sectional survey research design was employed to determine program directors’ (N = 90) views of credentialing issues. The health belief model and the transtheoretical model were used to determine perceived barriers, benefits, and self-efficacy with regard to promoting credentialing and readiness to require the CHES or CPH exam as part of the undergraduate curriculum. Ninety undergraduate programs completed the survey with the majority reporting that they do not require credentialing of faculty and students as part of their program of study. More than 70% of respondents, however, indicated that they thought credentialing in the fields of public health and health education/health promotion is an important issue. Most program directors indicated there is value in having students credentialed in health education or public health, yet few programs required the CHES or CPH exam as part of their curriculum or exit assessment. There are opportunities to use credentialing both in assessing program curriculum alignment with competencies and student mastery of said competencies.

Keywords

credentialing certification health education health promotion

Leaders in the health education and public health professions have been advocating for increased professional credentialing for almost two decades (Hampton et al., 2017; Lloyd, 2000). This emphasis was at least partially due to the 1988 Institute of Medicine report, The Future of Public Health, which declared the public health workforce in disarray and needing clearer direction (Walker, 1989). This news was not a surprise to professionals in one specialty area within public health, the health education specialists, who had begun developing their own credentialing exam over a decade prior (National Commission for Health Education Credentialing, Inc. [NCHEC] n.d.). Since this time, further role delineation has occurred among various specialties within health education/health promotion and public health. Much work regarding credentialing, however, is still needed for the health education/health promotion and public health professions, as practitioners continue to face confusion regarding their unique skills and abilities. Furthermore, health education/health promotion jobs continue to be filled by people having little or no specific health education or public health training (NCHEC, 2019). Since credentialing has been touted as a way to elevate the profession and bring exposure to the skills of properly trained professionals (Lloyd, 2000; NCHEC, 2019), the authors sought to determine the extent to which the three main health education and public health credentials, Certified in Public Health (CPH), Certified Health Education Specialist (CHES), and Master Certified Health Education Specialist (MCHES), are being promoted or required among faculty and students within public health and health education programs across the United States. This article summarizes these findings from a survey of undergraduate programs, and makes recommendations toward greater inclusion of certification requirements within academic training programs.

Background

In the past few decades, health education and public health have progressed as professions. The number of Schools of Public Health, Public Health Programs, and Standalone Baccalaureate Programs accredited by the Council on Education for Public Health (CEPH) has dramatically increased to approximately 200 schools (CEPH, n.d.). With less than half of these accredited prior to 2000 (Freudenberg et al., 2015), it is clear that exceptional growth within professional preparation programs is occurring in the field. This is particularly true for undergraduate programs where institutions offering undergraduate public health degrees grew from 83 in 2003 to 271 in 2016 with the majority of these degrees conferred in public health education and promotion (Resnick et al., 2018). Additionally, as schools of public health and health education have expanded, those practicing in academe have witnessed many health education programs transition into academic units aligned with public health, bringing opportunity for resources and advocacy regarding the roles and responsibilities of various health education or public health specialists (American Public Health Association [APHA], 2015).

Despite this growth, however, lack of information seems to exist among the general public and some hiring managers regarding the exact skills and abilities of health education and public health practitioners as opposed to differently trained individuals (NCHEC, 2019). In fact, professional organizations such as the Society for Public Health Education, APHA, and credentialing organizations such as the NCHEC have undertaken regular advocacy initiatives designed to help the public, especially those in a position to hire health education and public health professionals, better understand the responsibilities and competencies of various public health specialists, promote the professions, and highlight the skills of properly trained health education specialists and public health professionals (APHA, 2019; Hampton et al., 2017; NCHEC, n.d.; Thomas, 2018). One way to address this and further enhance opportunities for the profession is through certifications designed to verify individuals’ abilities to effectively practice the responsibilities, competencies, and subcompetencies within their chosen areas of health education and public health (Cottrell et al., 2009; Pierre Ste-Rose et al., 2015).

Currently, there are three main credentialing options for those in health education and public health. The first of these certifications, CHES, debuted in 1989 through a role delineation process (Pollock & Carlyon, 1996). Nearly two decades later in 2008, a certification titled CPH was initiated by the National Board of Public Health Examiners (NBPHE; Kurz et al., 2017). This was followed by the recently added MCHES credential in 2011. While the CHES and MCHES and the CPH do not validate the same skills and competencies, some individuals may be eligible to obtain both certifications (Dennis et al., 2012; Kerr et al., 2019). As the number of public health programs has increased across the United States, the number of individuals certified in one of these areas also has grown with over 7,000 individuals certified in public health since 2008 (A. Foster, personal communication, July 21, 2018), and over 29,000 having obtained the CHES credential by December 2017, and approximately 1,500 with the MCHES credential since its inception (L. Lysoby, personal communication, July 23, 2018). Further acknowledging their rigor and high standards, the CHES and MCHES certification exams are accredited by the National Commission for Certifying Agencies and the International Accreditation Service (NCHEC, n.d.). Additionally, the NBPHE conducted a job task analysis for CPH in 2014 and established a set of 200 job tasks in 10 public health domains to provide a foundation for refining the CPH exam (Kurz et al., 2017). Although some in the fields of public health and health education remain skeptical of the need for certification to document their skills, many appear to now consider it an added qualification that may enhance job opportunities for graduates of the burgeoning public health programs (Pierre Ste-Rose et al., 2015) and assure a level of knowledge or competency in one’s field (Kurz et al., 2017).

Certification also is viewed as enhancing the profession by providing expertise to the public and some level of quality assurance to employers (Dennis et al., 2012). Despite this, health educators and other public health practitioners often find themselves needing to explain their training and skills to those in the workforce and community. In fact, a previous survey (Gambescia et al., 2009) discovered that one third of replying employers stated that they did not currently hire health educators because they felt that others could perform those professional responsibilities. This does not appear to be as significant a problem in other fields, like nursing or pharmacy, which may compare to health education/health promotion or public health but require appropriate credentials for practice. Therefore, requiring or encouraging credentialing for graduates of undergraduate or graduate public health and public health education programs across the country may help increase understanding of how these individuals are uniquely trained to address today’s public health issues (NBPHE, 2019).

Academic institutions and faculty mentors are in unique positions to influence the next generation of public health practitioners and whether they pursue certification, but the question remains as to the benefits, barriers, and self-efficacy of faculty members and programs regarding such certifications. The current study utilized several constructs from the health belief model (HBM; perceived benefits, perceived barriers, self-efficacy, perceived severity, and perceived susceptibility) as well as assessing the participants’ current stages in the transtheoretical model (TTM; precontemplation, contemplation, preparation, action, maintenance) to answer this question. Both models have been widely used to assess a variety of health-related topics. For example, the HBM has been used to explain shared decision making (Muller, 2012) and public policy involvement by certified health education specialists (Mahas et al., 2016). Similarly, the TTM has been used in multiple settings including measuring the effectiveness of continuing education (Johnson et al., 2012), outcome evaluation for continuing education (Randhawa, 2012), and clinical practice online training courses (Murphy et al., 2018).

Currently, little recent research has been conducted as to how these three credentials are regarded and promoted by those involved in professional preparation programs and in the profession in general. This study focused on undergraduate preparation programs in order to assess support for credentialing for young professionals entering the field. Since the MCHES is an advanced certification, the focus was on the CHES and CPH credentials, which could be obtained by undergraduates, although for CPH an undergraduate degree and 5 years of experience are necessary. Additionally, this study measured faculty participants’ thoughts on the perceived benefits, barriers, susceptibility, severity, and self-efficacy related to credentialing, as well as their stage of change related to promoting credentialing among undergraduate students and colleagues or getting a credential themselves.

Method

Participants

Participants included directors of health education or public health undergraduate programs in the United States, selected based on a list of programs and contacts obtained from NCHEC and the CEPH website. These programs were specifically selected because the curriculum for CEPH-accredited programs often prepares students to take any of the three exams, CPH, CHES, or MCHES. Of the 262 programs researchers initially tried contacting to participate in the online survey, appropriate contact information could not be identified for 12% (n = 29), despite attempted phone follow-up and internet searches for accurate email addresses. Therefore, 233 emails were successfully delivered, with 119 participants opening the survey and 90 (39%) completing it. Based on participant responses, 32% (n = 29) were from programs having current accreditation through the CEPH. Of the faculty who primarily teach in the 119 programs represented in the data, a total of 70 (78%) individuals reported holding a credential, with 1% (n = 1) of programs requiring that faculty be credentialed and 2.2% (n = 2) recommending it. Program size ranged from 10 to 1,000 undergraduate majors.

Procedure

A cross-sectional design with single-point data collection was used to assess current certification or professional exam requirements for undergraduate programs in health education or public health. The survey design included questions assessing the participants’ stage in the TTM, selected to determine where the program might be on a scale from not at all considering requiring a certification exam to requiring all students to sit for a certification exam, as well as constructs from the HBM to determine the supports and barriers in place affecting requirements for certification exams. The included constructs were perceived benefits, barriers, susceptibility, severity, and self-efficacy. The perceived susceptibility construct was the only one to include Likert-type response options. Cues to action were not measured as they were outside of the scope of inquiry in the current study. Additional items were included to collect demographic information; however, no items were included that assessed the differences between health education–only, public health–only, or community health–only programs.

After approval from the institutional review board, potential participants were invited to complete the survey. These participants included program directors from each program. Some schools did not have the correct contact person included; thus, an internet search was conducted to identify the program director. If information for a particular program director was not available online, a researcher called the school and asked for the appropriate person to contact. Once contact information was identified for all potential participants, an initial email was sent inviting participants to complete a 15-minute survey using online data collection software (SurveyMonkey). A total of five emails were sent beginning in January 2018 and ending in March 2018 (approximately 2 weeks between emails), attempting to include as many participants as possible. One phone call occurred in the middle of the 3-month data collection period. This phone call was an attempt to reach potential participants, asking them to anticipate an email about the study and then to complete the online survey with the link included in the e-mail.

Instrument

The current study utilized a structured survey instrument to answer the research questions. Development of the questionnaire was preceded by a comprehensive literature review related to credentialing. Survey design included constructs from the HBM (perceived barriers, perceived benefits, perceived severity, perceived susceptibility, and self-efficacy) and the TTM stages of change (precontemplation, contemplation, preparation, action, maintenance, and relapse). Experts in survey design, health behavior theory, and the credentialing process reviewed the survey for face and content validity. A total of 39 items ranging from demographic questions to theoretical construct questions were included in the final questionnaire.

Health Belief Model

Perceived barriers

Potential barriers were assessed by asking participants the same question two times, once about the CHES exam and once about the CPH exam. Questions included, “What are some of the potential barriers of requiring undergraduate students to take the CHES exam as a graduation requirement?” and “What are some of the potential barriers of requiring undergraduate students to take the CPH exam as a graduation requirement?”

Perceived benefits

For a program to encourage or require students to sit for a credentialing exam, leaders must see its value. Therefore, perceived benefits were assessed by asking, “What are some potential benefits of requiring undergraduate students to take the CHES exam as a graduation requirement?” and “What are some potential benefits of requiring undergraduate students to take the CPH exam as a graduation requirement?”

Perceived susceptibility

Perceived susceptibility was assessed by asking, “What do you believe would happen if it was required for all health education/promotion professionals to be credentialed?” and “What do you believe will happen if the Health Education/Promotion profession continues to not require credentialing?” Researchers were attempting to determine whether program representatives believed there were any risks to the field if credentialing was either supported or not by most programs.

Perceived severity

Perceived severity was assessed by asking participants two questions. The first asked, “What do you believe would happen if it was required for all individuals in the field of health education/promotion to be credentialed?” The second question asked, “What do you believe will happen if the Health Education/Promotion profession continues to not require credentialing?” Again, researchers were attempting to determine the level of severity perceived by program representatives if credentialing was either supported or not by most programs.

Self-efficacy

To assess self-efficacy, a series of Likert-type scale questions were asked using strongly agree to strongly disagree as response options. Questions included, “I feel confident in accessing information regarding the CHES credential process,” “I feel confident in accessing information regarding the CPH credential process,” “I feel confident that I understand the difference between the CHES and CPH credentials,” “I feel confident that I could answer students’ questions regarding the CHES exam,” and “I feel confident that I could answer students’ questions regarding the CPH exam.” The goal for these questions was to determine whether program leadership felt they had easy access to and clear understanding about the necessary information regarding the main professional certifications in the field.

Transtheoretical Model

Stages of change

A participant’s current stage of change was initially measured by asking, “What is your program’s current curricular policy requiring undergraduate students to take the CHES and/or CPH exam as part of graduation requirements?” Response options included, “We currently do not require nor previously required students to take the CHES or CPH exam” (precontemplation); “We have not considered requiring either the CHES or CPH exam” (precontemplation); “We have considered either the CHES or CPH exam but have not created a plan to do so in the next 6 months” (contemplation); “We have considered the CHES or CPH exam and are planning on adopting this policy in the next 6 months” (planning); “We currently require all undergraduate students to take the CHES or CPH exam as part of our program requirements and have been doing so for less than 1 academic year” (action); “We currently require all undergraduate students to take the CHES or CPH exam as part of our program requirements and have been doing so for more than 1 academic year” (maintenance); “We currently require all undergraduate students to pass the CHES or CPH exam to qualify for graduation and have been doing so for less than 1 academic year” (action); “We currently require all undergraduate student to pass the CHES or CPH exam to qualify for graduation and have been doing so for more than 1 academic year” (maintenance); and “We previously required all undergraduate students to take the CHES or CPH exam but no longer do so” (relapse).

Descriptive statistics and frequencies were used to describe the population sample. Independent samples t tests were conducted to compare the response differences between CEPH accredited and nonaccredited programs on the HBM constructs of perceived benefits, barriers, severity, and susceptibility. However, as few significant differences were found between the accredited and nonaccredited programs, only descriptive statistics mean scores are reported. To assess construct validity, a principal components analysis using oblique (oblimin) rotation with Kaiser normalization was conducted. Four factors from the HBM (perceived benefits, perceived barriers, perceived susceptibility, and self-efficacy) had eigenvalues over Kaiser’s criterion of 1 and, when combined, explain 60% of the variance (Hair et al., 2014). Cronbach’s alphas ranged from .602 to .958. Supplemental Appendix A includes all eigenvalues.

Results

Participant Demographics

In total, 233 emails were successfully delivered, with 119 (51%) participants opening the survey and 90 (39%) completing it. Of those 90, most were female (68%; n = 61), were Caucasian (78%; n = 70), were over the age of 40 (84%; n = 76), held the academic rank of associate professor or higher (70%; n = 63), were tenured (58%; n = 52), were not the program director (51%; n = 43), were not the department chair (55%; n = 50), and held either the CHES/MCHES or CPH credential (70%; n = 63). Of those holding credentials, most held the CHES (30%; n = 27), followed by the MCHES (24.4%; n = 22) and the CPH (2.2%; n = 2). Those credentialed indicated holding this credential a range of 2 to 30 years. Participants also were asked specific questions about their institutions. Thirty-two percent of respondents (n = 29) reported their program had current accreditation through CEPH. Of the faculty who primarily teach in the 119 programs, a total of 70 individuals reported holding a credential with 1% (n = 0.9) of programs requiring that faculty be credentialed and 2.2% (n = 20) recommending it. Respondents reported enrollment sizes anywhere from 10 to 1,000 undergraduate students. Table 1 includes all demographic data.

Table 1.

Participant Demographics.

Characteristics	n (N = 90)	%
Gender
Female	59	67.8
Male	28	32.2
Race/ethnicity
White/Caucasian	70	77.8
Black/African American/African	7	7.8
Asian/Pacific Islander	4	4.4
Hispanic/Latino	3	3.3
Other	3	3.3
Age, years
31–40	16	17.8
41–50	23	25.6
51–60	20	22.2
61–70	15	16.7
71+	4	4.4
No response	12	13.3
Faculty rank
Assistant professor	14	15.6
Associate professor	32	35.6
Full professor	31	34.4
Lecturer/instructor	7	7.8
Other	6	6.6
Additional information
Tenured	52	57.8
Program director	44	48.9
Department chair	44	48.9
Credentials	47	52.2
Total
Certified Health Education Specialist	27	30
Master Certified Health Education Specialist	22	24.4
Certified in Public Health	2	2.2

Respondents were also asked “What are the reasons/justifications for requiring credentialing (mark all that apply?).” Twenty percent (n = 18) indicated that their faculty support student credentialing, 18% (n = 17) indicated it was a method of assessment for program outcomes, 19% (n = 17) said credentialing gave students an advantage in the job market, 12% (n = 11) said it adds visibility to the profession, 13% (n = 12) said it is a measure of program rigor, and 8% (n = 7.2) indicated credentialing is a marketing tool. Furthermore, 2% (n = 2) of programs reported covering the student registration for certification exams. Of those who require exams as part of their program, 26% (n = 23) said they received individual scores for the CHES (students self-report) and 3% (n = 3) said the same for the CPH. Furthermore, 46% (n = 41) of responding programs indicated they received aggregate scores from NCHEC for CHES and 3% (n = 3) from the Association of Schools and Programs of Public Health for the CPH.

Transtheoretical Model

Participants reported stages of change primarily in precontemplation or contemplation (see Table 2). Specifically, 43% (n = 39) currently do not (and previously did not) require the CHES or CPH exams for their students (precontemplation), 33% (n = 30) indicated they are not considering the CHES or CPH exams (precontemplation), 17% (n = 15) reported considering either the CHES or CPH exams but had not created a 6-month plan to do so (contemplation), 2% (n = 2) reported considering either the CHES or CPH exams and have a 6-month implementation plan (preparation), and 4% (n = 4) currently require all undergraduate students to take the CHES or CPH exams as part of program requirements (action). Of those programs who currently require or are considering requiring either certification for students, 12% (n = 11) indicated CHES, while 11% (n = 10) said either the CHES or the CPH but had not decided which one. Furthermore, 81% (n = 73) said they felt their program prepared students to take the CHES exam with 19% (n = 17) indicating the same for the CPH exam. Thirty-seven percent (n = 33) of respondents reported offering some type of exam preparation for students for the CHES exam, and 5% (n = 5) indicated the same for the CPH exam.

Table 2.

Stages of Change for Programs Requiring CHES or CPH Exams for Students.

Stage of change	n (N = 90)	%
Precontemplation	69	76
Contemplation	15	17
Preparation	2	2
Action	4	4

Note. CHES = Certified Health Education Specialist; CPH = Certified in Public Health.

Health Belief Model

Descriptive statistics were run for all constructs. The mean, standard deviation, and standard error scores can be found in Table 3.

Table 3.

Descriptive Results for Perceived Barriers, Benefits, Susceptibility, and Severity Constructs of the Health Belief Model and Credentialing Exams Being Required for Students.

Variable	M (N = 90)	SE of M	SD
Perceived benefits
Ensure baseline level of competency	.50	.045	.424
Bring recognition to the profession	.50	.042	.397
Increase likelihood health educators are hired over other professionals	.41	.044	.417
Facilitate reimbursement for health education/promotion services	.31	.044	.414
Serves as a program outcomes measure	.63	.042	.401
Helps with outcomes documentation for accreditation	.54	.047	.445
Evaluates curricular alignment with professional competencies	.57	.043	.408
Perceived barriers
Our faculty will not support this.	.22	.040	.376
It is too expensive for students.	.53	.044	.413
Credential is not valued.	.17	.033	.311
Students should just take it on their own.	.19	.036	.341
Our curriculum would not prepare them.	.09	.027	.255
Students would be upset if we required.	.32	.043	.407
Employers do not value this credential.	.23	.040	.384
Perceived susceptibility
No one would adhere to this requirement.	.02	.016	.148
Some would adhere to this requirement.	.37	.051	.485
Most people would adhere to this requirement.	.39	.052	.490
Everyone would adhere to this requirement.	.12	.035	.329
Unsure.	.16	.038	.364
Perceived severity
We will lose jobs to other professions.	.41	.052	.495
There will not be reimbursement for health education/promotion services.	.30	.049	.461
Health educators will lose their professional identity.	.32	.050	.470
Health education/promotion professionals will seek out other certifications.	.56	.053	.500
Nothing will change.	.30	.049	.461
Self-efficacy
I feel confident in accessing information regarding the CHES exam.	.85	.038	.355
I feel confident in accessing information regarding the CPH exam.	.58	.054	.497
I feel confident that I understand the difference between the CHES and CPH credentials.	.55	.053	.500
I feel confident that I can answer students ‘questions regarding the CHES exam.	.80	.042	.402
I feel confident that I can answer students ‘questions regarding the CPH exam.	.37	.051	.485

Note. CHES = Certified Health Education Specialist; CPH = Certified in Public Health.

Perceived Benefits

Descriptive statistics revealed that more than half of respondents (see Table 3) felt that requiring either the CHES or CPH exam would help to ensure a baseline level of competency (50%), bring recognition to the profession (50%), help with outcome documentation for accreditation (54%), and evaluate curricular alignment with professional competencies (57%). However, 30% believed it would help with reimbursement for health education/promotion services, while 41% thought it would increase the likelihood that health educators are hired over other professionals.

Perceived Barriers

The majority of respondents felt that it was too expensive to require a credentialing exam of students (53%), while far less than the majority reported other barriers. Nine percent said their curriculum would not prepare students for credentialing exams, 17% said the credentials are not valued, 19% report that students should take an exam on their own, 22% felt faculty would not support this, 23% indicated that employers do not value credentialing in the field, and 32% said student would be upset if a credentialing exam were required of them. See Table 3 for full statistics.

Perceived Susceptibility

Descriptive statistics were also used to assess perceived susceptibility on a Likert-type scale. With regard to requiring a credentialing exam as part curriculum, respondents reported that they felt no one would adhere to requirement (2%), some would adhere to the requirement (37%), most would adhere (39%), everyone would adhere (12%), and some were unsure (16%).

Perceived Severity

The majority of respondents agreed that if CHES or CPH certification is not required of health education specialists, they will seek other credentials (56%). However, only 41% felt that the profession would lose jobs, 32% indicated that health educators will lose their professional identity, 30% said there would not be reimbursement for health education/promotion services, and another 30% also said nothing would change. See Table 3 for full statistics.

Self-Efficacy

The overwhelming majority of respondents indicated that they felt confident in accessing CHES exam information (85%) with 80% saying they felt confident in their ability to answer students’ questions about this exam. For the CPH exam, 58% felt confident in their ability access information regarding this exam, while 37% reported feeling comfortable answer students’ questions about the exam.

Discussion

Credentialing opportunities in health education and public health have been available for some time and yet “buy-in” from faculty in these undergraduate programs seems to be marginal (Dennis et al., 2012). In the study reported here, even though 70% of the participants felt credentialing exams were important, few programs are requiring credentialing of faculty and students. In fact, one third of the respondents stated their programs were not considering either exam for students, or will not consider adding a credentialing exam as a graduation requirement anytime soon. The small number of programs who require students to take a credentialing exam is somewhat surprising, given some of the benefits of having the credential and since it can be viewed as a step toward the professional socialization of students joining the public health workforce (Hayden, 1995).

The results of this study seem to suggest that faculty do not see an overwhelming value in personally having either the CHES/MCHES or CPH credential and do not have the credential themselves. The findings of this research are reinforced in other published literature and professional conversation within the discipline (Dennis et al., 2012). This may be because faculty hold advanced degrees and might feel this takes the place of having a credential in the field. Additionally, they may feel that experience over time replaces the need for one of these credentials. Interestingly, faculty in this study also did not require a credential in advertised faculty job openings. Because credentialing in health education and public health is not a requirement for professional practice, it has not been adopted to the extent that it has in other professions who require it, such as social work, counseling, or dietetics. Perhaps if it were a requirement for the profession, or reimbursement of health education services occurred, it would entice professionals to obtain certification (Doyle & Cissell, 1998). It should be noted that while many faculty do not have a health education or public health credential, respondents did identify some important benefits for students achieving certification. Results showed participants felt that taking the CHES or CPH exam for a graduation requirement is a good way to ensure baseline levels of competency, and that not having a certification could result in job loss, could lead to loss of recognition of the profession, or may even prevent third-party reimbursement of services from being achieved. This belief seems incongruent with the fact that few undergraduate programs require the certification exam (only 4% of programs in this study) or provide study sessions or materials for students.

Although this study did not find any potential barriers to student credentialing to be of significance, if the profession is to increase the number of students who seek certification, several barriers should be addressed. First, programs may consider paying students’ registration fees for the exam, as registration fees can be costly for students and new professionals. In the current study, only a few programs indicated this practice. The study materials and exam fee could also be added to the student fees required by the program, so students could use their financial aid to assist with paying the fees. Second, only a small number of respondents indicated they offered or provided study sessions for students to prepare for the certification exam. This may be due to the fact that faculty are often stretched in many areas and hosting study sessions is not part of anyone’s job description or may not count toward promotion and tenure. While a large majority of faculty indicated a high degree of self-efficacy in locating materials to study and prepare for the credentialing exams, as noted above, few programs actually provide study sessions for students. Programs could also refer students to online study materials and groups, such as those provided by NCHEC and Society for Public Health Education in the case of the CHES exam. Third, while the majority of programs (81%) indicated their curriculum prepared students to take a certification exam, about one in five programs indicated that it did not adequately prepare students. This appears to be a gap in student learning outcomes to demonstrate competency in professional responsibilities and inconsistent with having curricular alignment with professional domains and competencies, which could reduce the likelihood of a program being CEPH accredited.

Although results indicated no barriers in making certification a requirement for faculty and students, and faculty thought credentialing exams were important for many aforementioned reasons, there remains a gap in actualizing a plan to incorporate these exams in personal and program practice (Doyle & Cissell, 1998). Clearly there is work to do if certification and personal credentialing are deemed important in the future of public health and health education/health promotion.

Limitations

There are limitations to the current study. The small sample size may affect the generalizability of the study to the extent that the perceptions reported in this study may not adequately represent all undergraduate programs in health education and public health. Additionally, because of the nature of anonymous surveys, data including numbers of respondents from NCHES or CEPH lists are not available. While the intent of this study was for undergraduate program directors or department chairs to complete the survey, a large percentage of the sample were not currently in either of these positions. Not currently serving as a program director or department chair could affect the validity of the findings if these respondents have different views or perceptions than those making curricular decisions or receiving student scores from the credentialing exams. There also were a small number of faculty familiar with the CPH certification, likely because the contact list was obtained from NCHEC (perhaps individuals who are more likely to be familiar with and support CHES/MCHES), and thus their perceptions regarding the constructs measured within the HBM may not be valid. In addition, there were no questions that teased out whether surveyed programs were public health–only, health education–only, or both. This particular study assessed only undergraduate credentialing perceptions and not graduate students or advanced levels (e.g., MCHES), which are more likely to include the CPH exam. Finally, the monothematic nature of the survey may have biased the respondent to answer the survey questions in a socially desirable way.

Conclusion

There are several interesting findings of this study that seem to create a paradox where there is some perceived benefit from having a certification and yet many professionals still choose to neither obtain certification nor promote it among their undergraduate students. Additionally, there is not a preponderance of evidence to suggest that being credentialed will necessarily equate to job security or a higher level of mastery, particularly in those with advanced degrees. The impact of having a certification in a profession is difficult to assess when credentialing is voluntary and it comes in various forms (CPH vs. CHES, MCHES). Further study of this topic is recommended. Additionally, next steps could be surveying local departments of health as well as students on their perceptions of the benefits of the three certifications.

If, however, the profession is to make a “cultural shift” to increase the value of credentialing in the field, it would seem that this would need to begin during professional preparation programs and should be modeled and valued by professionals in the field. Moreover, given that curricula should be aligned with the professional competencies of the health education and/or public health fields, it would seem appropriate to use the credentialing exams as an indicator of program success. At the program and department levels, there should also be recognition of faculty effort (compensation, course release, etc.) for those going above and beyond their course loads to help prepare students to take certification exams. Finally, it is recommended that programs begin to assess the viability of requiring students to take a certification exam as part of their program of study to benchmark the students’ mastery of the professional competencies and inform department chairs/program directors about possible gaps in professional preparation.

Supplemental Material

Appendix_A_6.2.20 – Supplemental material for Faculty Perceptions of Certifications in Health Education and Public Health: Implications for Professional Preparation

Supplemental material, Appendix_A_6.2.20 for Faculty Perceptions of Certifications in Health Education and Public Health: Implications for Professional Preparation by Alexis Blavos, Dianne Kerr, Heidi Hancher-Rauch, Jodi Brookins-Fisher and Amy Thompson in Pedagogy in Health Promotion

Footnotes

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 iDs

Alexis Blavos

Heidi Hancher-Rauch

Supplemental Material

Supplemental material for this article is available online at .

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