Pedagogy in Health Promotion

In 2016, the U.S. Department of Health and Human Services Office of the Assistant Secretary for Health launched the Public Health 3.0 initiative to define a framework for the future of public health. Regional Public Health Training Centers are at the forefront of testing new pedagogical approaches that incorporate Public Health 3.0 and social determinants of health principles.

Internships and field placements are a critical component of public health education in that they help ensure that future public health workers are able to apply theory and concepts to practice. However, developing successful practice-based experiences is dependent on both public health agencies and academic institutions collaborating to identify the competencies students should possess on entry into the field. It also takes considerable time and resources from public health departments to make these field placements successful. Seeking to innovate on existing field placement models in an effort to provide a rich relationship between students and practitioners, the Tennessee Department of Health has developed a new fellowship experience for recent graduates of public health programs that draws on the multidisciplinary aspects of post-graduate medical education. The Commissioner’s Fellowship in Public Health provides recent graduates an opportunity for practical high-level experiential learning in place of—or prior to—additional academic work. The program has two overarching goals: (1) to address emerging needs of public health in the areas of health policy and primary prevention while providing leadership, professional opportunities, and practical experience to recent graduates that will serve as a foundation for a career in public health; and (2) to provide a high level, diverse, and extended post-graduate population health experience prior to committing to a particular field.

In 2013, the Health Resources & Services Administration redesigned the long-standing Public Health Training Center program to meet the training needs of the modern public health workforce and to implement parts of the Patient Protection and Affordable Care Act, which sets the training, recruitment, and retention of public health workers as a priority. Understanding that today’s most significant public health threats are socially constructed, resulting in chronic disease and significant years of life lost, the Health Resources & Services Administration laid the groundwork for the creation of a nationally unified network of training centers—the Public Health Learning Network (PHLN). The PHLN is the nation’s most comprehensive system of public health educators, health experts, thought leaders, and practitioners working together to advance public health training and practice. The system comprises 10 regional public health training centers, 40 local performance sites, and a National Coordinating Center for Public Health Training. The PHLN strengthens the workforce in state, local, and tribal health departments, as well as community health centers and primary care settings, to improve the capacity of a broad range of public health personnel to meet the complex public health challenges of today and tomorrow.

Developing a public health training center has provided a unique opportunity to meet the training needs of the public health workforce across North Carolina. Furthermore, the training center has fostered collaborations with community partners and other universities in the state. This article describes some lessons learned while building a local performance site that may help inform and shape expectations about what it takes to build a public health training center. Recommendations for successfully creating a local performance site within the Regional Public Health Training Center model are included.

Improving population health requires a comprehensive array of interventions across individual, organizational, and community levels. Integrating primary care and public health strategies through partnerships is one type of intervention. Workforce development can facilitate this type of integration; however, models and modalities of workforce training primarily focus on individual skill building and may not build the capacity needed for collective action. A collaborative and strategic learning approach, communities of practice, fosters primary care and public health integration to address population health. A Health Resources and Services Administration–funded multistate regional Public Health Training Center (PHTC), the Great Lakes PHTC, undertook an action learning process to develop and pilot a workforce development initiative to promote ongoing learning toward shared goals. Great Lakes PHTC facilitated 11 discussions throughout the region with a total of 100 participants from primary care and governmental public health communities to better understand perceptions, gaps, barriers, and opportunities for integration and training. Findings indicated that a regional, coordinated model to workforce development provided a process for improved, ongoing learning that uncovered gaps in adapting distance-based approaches that can be addressed in future programming efforts. In addition, the process revealed that addressing population health issues through integrated partnerships requires training beyond content and discipline that incorporates multiple modalities and models.

The mission of the Region IV (R-IV) Public Health Training Center (PHTC), headquartered at the Rollins School of Public Health at Emory University in Atlanta, GA, is to develop and implement programming to train and educate public health professionals in U.S. Department of Health and Human Services Region IV. To identify public health workforce development needs, the R-IV PHTC created a systematic process that included the implementation of a variety of strategies, to gain insights from each state within the diverse region. Conducting regular needs assessments is an integral step to ensure trainings are relevant and meet the needs of public health professionals. To this end, the PHTC employed a mixed methods approach to gather information on both competency-based and non–competency-based training needs, as well as training needs within R-IV’s content focus area of infectious disease. In R-IV there is great variability between the structures of the state and local health departments (e.g., some centralized, some decentralized), each of which faces different funding challenges and works with different service delivery models and regulatory authorities. Moreover, states have diverse populations (e.g., races, urban/rural, migrant/refugees, tribal, Appalachian) and face a wide range of public health priority concerns. Health departments were found to be at different stages of readiness to undertake a training needs assessment due to a number of issues, including their stage of pursuing Public Health Accreditation Board accreditation and recent participation in other needs assessment efforts. The R-IV PHTC approach to assessing training needs within this challenging environment is described.

The Public Health Learning Network is the nation’s most comprehensive system of educators, public health experts, and thought leaders whose mission is to advance public health practice and improve population health in the United States. One of 10 regional centers in the Public Health Learning Network, the Midwestern Public Health Training Center Regional Coordinating Center has developed expertise in the development of competency-based eLearning to meet the training needs of the public health and health care workforce. eLearning has become a widely used method for providing online training to strengthen a learner’s knowledge, skills, and attitudes. This article discusses the use of the analysis, design, development, implement, and evaluate model as a standard for instructional design and best practice elements of eLearning. Two examples of eLearning programs are provided, along with data on level of interactivity and Kirkpatrick Level 1 and 2 evaluation results. Evaluation data indicate that users’ experiences have been positive.

The mission of the Region IV (R-IV) Public Health Training Center (PHTC), headquartered at the Rollins School of Public Health at Emory University in Atlanta, Georgia, is to develop and implement programming to train public health professionals in the U.S. Department of Health and Human Services Region IV. The emphasis on public health accreditation, as well as the reality of high personnel turnover and a workforce with little formal training, point to the need for PHTCs that provide workforce training. PHTCs use distance-based education to reach those in need of training by minimizing or eliminating cost and travel barriers. However, many experienced public health trainers who are able to provide effective and engaging trainings in person lack the knowledge and skills necessary to adapt existing curricula to a distance format. Distance Education And Learning (DEAL) is an online course designed by the R-IV PHTC to increase the capacity of public health trainers to teach in the distance learning environment. The course includes four 3-hour synchronous online sessions with additional asynchronous presession and intersession activity requirements. This article describes the development and implementation of the DEAL course, including how it is used by the R-IV PHTC to increase the number of public health trainers with the skills needed to develop and implement distance-based training, which thereby builds the training capacity within the region and addresses issues of sustainability.

The proliferation of webinars and other similar web-based educational offerings attests to the interest in this instructional modality on the part of educators and learners in the public health workforce. While certain advantages of Internet-based training, including time and costs savings for learners, are evident, it is important to establish the impact of this medium on a variety of health care disciplines. To this end, a search was performed of individual studies and review articles published since 2005 that discuss the use of these methodologies by several disciplines in the domain of public health, with particular attention on randomized controlled trials and meta-analytic studies. Reports over the past decade support the belief that the health care workforce is generally satisfied with Internet-based training and that this type of training yields measurable changes in knowledge and behavior. Overall, the data strongly suggest that these techniques are better than no intervention and essentially equivalent to conventional instructional techniques. However, the specific elements that actually improve the educational value of web-based educational technologies and the evidence base for best practices in the field have yet to be identified.

Extension for Community Healthcare Outcomes (ECHO) is a model for professional training and support now being used widely in clinical health care. ECHO provides training for health care professionals in their own communities by creating peer learning groups connected by live bidirectional video communications. Topic experts lead the sessions, but most of the learning occurs through case presentations and consultations. Although similar to telemedicine, ECHO differs in that the responsibility for patient care remains with the primary care learners. The Rocky Mountain Public Health Training Center—which supports training for the public health workforce in the six-state region of Colorado, Utah, Wyoming, Montana, and North and South Dakota—has adapted the ECHO health care model for public health training, using the ECHO learning principles of creating and supporting peer learning networks connected by live bidirectional video, and employing a case-based learning approach. The public health ECHO trainings are facilitated by subject matter experts, focus on real-life public health challenges, and use programs or scenarios within communities as “cases.” This article looks at early success in using the ECHO model for public health training on topics such as local public health agency quality improvement, patient navigation, food safety, tobacco control, obesity prevention, tuberculosis management, and HIV prevention. The Rocky Mountain Public Health Training Center continues to refine its implementation of the ECHO learning model across a wide range of public health and population health topics and shows great promise as a framework for regional public health training.

The Western Region Public Health Training Center (formally the Arizona Public Health Training Center) conducts competency-based needs assessments and provides workforce development assistance to public health agencies in the U.S. Department of Health and Human Services Region IX. Since its launch in 2012, the Center’s Public Health Essentials in Action Training has evolved. It is now offered in-person and online and has been adapted for rural communities. The evolution of the training, beginning with course planning and development, is described, as well as how factors in the public health workforce influenced the course’s evolution and how the course has been adapted for different platforms and populations. Finally, an overview of evaluation efforts offers insight into course effectiveness for this and other trainings offered by the Western Region Public Health Training Center.

In the past few years, the drive for public health department accreditation has continued to build momentum. As the Centers for Disease Control and Prevention notes, “Engaging in accreditation catalyzes quality and performance improvement within all public health programs and can help health departments be better prepared to proactively respond to emerging and reemerging health challenges”. Many organizations support accreditation efforts, including the Public Health Training Centers (PHTCs), which have been providing workforce development support since 1999. This article describes how one PHTC, the Midwestern Public Health Training Center, has supported capacity building for accreditation in partnership with other state-based organizations through the development of three major accreditation readiness activities: accreditation workshops, informational videos on Public Health Accreditation Board standards and measures, and competency-based workforce development assessments. Given the current and emerging public health challenges, the need for a well-prepared workforce is more important than ever to strengthen the public health system, and by engaging in activities to meet the accreditation standards, public health departments will be better positioned to respond to these challenges. PHTCs will continue to have a critical role in capacity building for accreditation.

Public health departments provide many services critical to maintaining healthy populations, including communicable disease control, immunizations, primary care, and emergency preparedness. The Public Health Accreditation Board (PHAB) has established an accreditation process for public health departments that measures departmental performance against nationally recognized, evidence-based standards. The goal is to recognize departmental strengths and weaknesses, strengthen partnerships, and promote the prioritization of organizational goals to improve community health. Achieving accreditation from the PHAB requires health departments to develop Community Health Assessment (CHA), Community Health Improvement Plan (CHIP), and Strategic Plan processes. The intent of the CHA is to determine contributing factors for poor health outcomes and assess available resources. Building on the CHA, the CHIP establishes health priorities and improvement strategies, including measurable health outcomes and recommended policy changes. Finally, Strategic Plan defines the health department’s strategic priorities, goals, and implementation plans. A number of methodologies are available to develop these plans, but many prove to be complicated and confusing, leading to suboptimal performance. The Alabama-Mississippi Public Health Training Center assisted the Alabama Department of Public Health with the creation of their plans by developing the Focused Strategic Thinking Approach, which supplied simple and effective processes to develop useful and successful plans. These processes provide useful guides for other public health departments developing their prerequisites as they pursue PHAB accreditation.

Experiential learning links knowledge to real practice through seasoned mentor support, professional reflection, and hands-on experience in authentic work environments. While academic public health programs seek to train the future workforce, the current workforce has a critical need for training as well. The Region IV Public Health Training Center’s Pathways to Practice Scholar program gives public health students the opportunity to apply knowledge to competency-based experiences while fulfilling the current workforce’s short- and long-term human resource needs. Placements are offered in all eight states of the region to broaden opportunities for both agencies and student scholars. On completion of the program, scholars are required to submit an executive summary, reflection statement, photos of the experience, and a draft abstract suitable for submission to a professional conference. Since 2015, 36 scholars have been placed in positions across Region IV, 11 in states other than those of their home universities. Students were placed at state, local, and tribal health departments; area health education centers (AHECs); and other agencies (e.g., primary care settings), and the most common work plan domains selected by scholars were analytic/assessment, policy development/program planning, and leadership/systems thinking skills. Scholars’ perceived confidence increased across all domains with the highest increases in financial planning/management and cultural competency. Program implementation and evaluation findings are described, including types of projects, differences in confidence in performing competency domains, and confidence and interest in working with underserved populations. Evaluation findings indicate that the Region IV Public Health Training Center scholars increased their confidence in performing practice competencies while providing support for public health agencies serving underserved populations.

The state of Nebraska has a growing number of refugees with diverse backgrounds and health needs. To address these needs, a collaborative project was developed by the local performance site of the Midwestern Public Health Training Center at the University of Nebraska Medical Center, College of Public Health, and the Nebraska Department of Health and Human Services, Division of Public Health, Office of Women’s and Men’s Health. The purpose of this 2-year project is to improve the quality of services offered by the Office of Women’s and Men’s Health by assessing risk, knowledge, and preventive screening practices in refugee populations and provide recommendations to increase cancer-screening rates. The focus of the project was on cervical cancer prevention of Somali women refugees in Nebraska. In Year 1 of the project (2015-2016), a Refugee Screening Collaborative was created to provide input and recommendations throughout the project; focus groups and a literature review were completed to explore the knowledge, attitudes, and beliefs of cervical cancer screening and human papillomavirus vaccine among refugees and health care providers; and recommendations were made for the development and implementation of curricula and interventions that address the unique cultural and literacy needs of the population. This project demonstrates the importance of the Public Health Training Center program for building mutually beneficial partnerships between academia and practice.