Empowering adult patients with diabetes for health educators' role within their family members: A cross-sectional study.

BACKGROUND: Patient engagement as partners in diabetes prevention for family members/close relatives is a novel and underexplored approach. This paper aims to assess patients' willingness and confidence in their ability to succeed as health educators for their family members and investigate the influencing factors. METHODS: A cross-sectional descriptive study was conducted between January 2023 and April 2023. A newly developed and validated self-reported questionnaire, based on the Health Belief Model (HBM) and previous research, was administered to a convenient sample of 134 adult participants diagnosed with diabetes. These participants sought care at primary healthcare clinics at King Abdul-Aziz Medical City, Ministry of National Guard Health Affairs in Riyadh and Jeddah (MNGHA). The data was examined using statistical methods including descriptive analysis, ANOVA, Tukey's HSD (Honestly Significant Difference) Post Hoc tests, and Pearson's correlation coefficients. RESULTS: The majority of participants expressed a willingness to assume the role of health educators for their family members (n = 117, 87.31%) and reported a high level of willingness and confidence, as indicated by self-efficacy scores ranging from 12.00 to 25.00, with a mean of 21.12 (SD = 2.76). Participants' willingness to be health educators exhibited positive correlations with their perceptions of diabetes severity and susceptibility (r = .433, p < .01), perceived benefits and barriers (r = .451, p < .01), cues to action (r = .520, p < .01), self-efficacy (r = .789, p < .01), and the total score of the questionnaire (r = .640, p < .01). CONCLUSIONS: The majority of participants expressed their willingness to assume the role of health educators for their family members, and a significant portion reported confidence in their capacity to accomplish this objective. Healthcare providers should emphasize the importance of equipping patients with the skills and knowledge necessary to effectively convey health messages and serve as health educators within their communities. This expansion of the approach holds the potential to have a significant impact on public health strategies for diabetes prevention.

Aspiring to Disability Consciousness in Health Professions Training.

Lack of disability-competent health care contributes to inequitable health outcomes for the largest minoritized population in the world: persons with disabilities. Health care professionals hold implicit and explicit bias against disabled people and report receiving inadequate disability training. While disability competence establishes a baseline standard of care, health professional educators must prepare a disability conscious workforce by challenging ableist assumptions and promoting holistic understanding of persons with disabilities. Future clinicians must recognize disability as an aspect of diversity, express respect for disabled patients, and demonstrate flexibility about how to care for disabled patients' needs. These skills are currently undervalued in medical training, specifically. This article describes how integrating disability consciousness into health professions training can improve health equity for patients with disabilities.

Identifying Value Factors in Institutional Leaders' Perspectives on Investing in Health Professions Educators.

Importance: Investing in educators, educational innovation, and scholarship is essential for excellence in health professions education and health care. Funds for education innovations and educator development remain at significant risk because they virtually never generate offsetting revenue. A broader shared framework is needed to determine the value of such investments. Objective: To explore the value factors using the value measurement methodology domains (individual, financial, operational, social or societal, strategic or political) that health professions leaders placed on educator investment programs, including intramural grants and endowed chairs. Design, Setting, and Participants: This qualitative study used semi-structured interviews with participants from an urban academic health professions institution and its affiliated systems that were conducted between June and September 2019 and were audio recorded and transcribed. Thematic analysis was used to identify themes with a constructivist orientation. Participants included 31 leaders at multiple levels of the organization (eg, deans, department chairs, and health system leaders) and with a range of experience. Individuals who did not respond initially were followed up with until a sufficient representation of leader roles was achieved. Main Outcomes and Measures: Outcomes include value factors defined by the leaders for educator investment programs across the 5 value measurement methodology domains: individual, financial, operational, social or societal, and strategic or political. Results: This study included 29 leaders (5 [17%] campus or university leaders; 3 [10%] health systems leaders; 6 [21%] health professions school leaders; 15 [52%] department leaders). They identified value factors across the 5 value measurement methods domains. Individual factors emphasized the impact on faculty career, stature, and personal and professional development. Financial factors included tangible support, the ability to attract additional resources, and the importance of these investments as a monetary input rather than output. Operational factors identified educational programs and faculty recruitment or retention. Social and societal factors showcased scholarship and dissemination benefits to the external community beyond the organization and to the internal community of faculty, learners, and patients. Strategic and political factors highlighted impact on culture and symbolism, innovation, and organizational success. Conclusions and Relevance: These findings suggest that health sciences and health system leaders find value in funding educator investment programs in multiple domains beyond direct financial return on investment. These value factors can inform program design and evaluation, effective feedback to leaders, and advocacy for future investments. This approach can be used by other institutions to identify context-specific value factors.

Feasibility of delivering survivorship care via lay health educators: A pilot randomized controlled trial among rural cancer survivors.

PURPOSE: We tested the feasibility of survivorship care plan (SCP) delivery with/without a lay health educator (LHE) telephone-delivered information session among rural cancer survivors, and their effects on health-related self-efficacy and knowledge of cancer history. METHODS: Randomized trial of cancer survivors from 3 rural oncology clinics featuring either SCP alone (control) or SCP plus LHE-delivered information session (intervention). Participants completed a questionnaire on health-related self-efficacy and knowledge of cancer-specific medical history. Responses were compared to medical records for accuracy. SCPs were then mailed to participants. Approximately 5 months later, participants completed a follow-up questionnaire. A subset of participants took part in subsequent qualitative interviews about their study experience. FINDINGS: Of 301 survivors approached, 72 (23.9%) were randomized (mean age 66.4 years; 3.1 years from diagnosis; 62.5% female), and 65 (90.3%) completed the study. Global mental and physical health or self-efficacy scores did not change significantly from baseline to follow-up for either group. In exploratory analyses, self-efficacy increased in participants with inadequate/marginal health literacy in the intervention arm (+0.7, 95% CI = 0.1-1.2; P = .01). Accuracy of knowledge did not improve but was high at baseline (mean 76.0±14.5%). 60.1% and 48.4% of control and intervention participants, respectively, found SCPs definitely/somewhat useful. Qualitative data (n = 20) suggested that SCPs were helpful to patients when primary and oncology care were less integrated. CONCLUSIONS: An LHE-delivered informational session was feasible but had limited benefit to rural cancer survivors versus delivery of SCP alone but may be of benefit to patients with low health literacy or with less integrated care.

Intervention Characteristics Considered in Health Educators' Adoption Decision-Making Process.

It is well known that perceptions of intervention characteristics (e.g., cost, source, evidence strength and quality) are a critical link from dissemination to implementation. What is less known is the process by which researchers understand the characteristics most valued by key intermediaries (i.e., real-world decision-makers), particularly in the federal system of Cooperative Extension. In Extension, university-based specialists are available to assist county-based agents in program selection, delivery, and evaluation. For this work, a sequential explanatory mixed-methods design was used to conduct surveys and semi-structured interviews, informed by the Diffusion of Innovations theory and Consolidated Framework for Implementation Research. Educators and specialists were recruited across 47 states to identify characteristics of health promotion interventions that facilitate the adoption decision-making process. Analysis of intervention attribute importance survey data was conducted through a one-way ANOVA with Bonferroni post hoc test to determine individual variable differences between responses. Interviews underwent a conventional content analysis. In total, 121 educators and 47 specialists from 33 states completed the survey. Eighteen educators and 10 specialists completed interviews. Educators and specialists valued components such as the community need for the intervention, and potential reach compared with other components including previous delivery settings and external funding of the intervention (p < .05). Qualitative data indicated divergence between educators and specialists; educators valued understanding the intervention cost (time and training) and specialists valued the evidence base and external funding available. Intervention developers should communicate information valued by different stakeholders to improve the adoption of evidence-based interventions.

Evolution and growth of the ECHO (Enriching Communication skills for Health professionals in Oncofertility) program: a 5-year study in the training of oncofertility professionals.

PURPOSE: AYAs with cancer have unique psychosocial needs, with reproductive health being a primary concern. The ECHO training program provides reproductive health communication training to individuals providing care for AYAs with cancer. The purpose of this project is to describe the growth of ECHO and evaluate changes in learner engagement over a 5-year period. METHODS: ECHO is an 8-week online training program offered annually, with the program including learning modules, discussion topics and reflections, and synchronous discussions. Reflection quality scores and number of words were compared between the 5 cohorts using ANOVA with a p < .05 level of significance. Descriptive statistics summarized module topics, reflections, and synchronous discussions. RESULTS: The average number of reflections per unique learner increased each year (1.4 in cohort 1 vs 4.1 in cohort 5), as did average length and quality of reflections (72.1 words in cohort 1 vs 203.4 words in cohort 5, p < .0001; score of 1.21 in cohort 1 vs 4.46 in cohort 5, p < .0001). The percentage of learners in attendance at synchronous discussions increased between cohorts 4 and 5 (4.8% of learners in cohort 4 vs 18.8% of learners cohort 5). CONCLUSIONS: The ECHO program has seen significant growth and improvement in learner engagement over a 5-year period. This is particularly important given that student learning outcomes in online courses can be predicted by the level of engagement with online content. IMPLICATIONS FOR CANCER SURVIVORS: As fertility and reproductive health remain a top life goal and discussion priority for AYAs surviving cancer, increasing clinical competencies of AHPs in oncofertility is essential.

Evaluation of a Brief, Tailored Skin Cancer Risk Assessment and Referral Intervention for Community-Based Health Educators: Brief Report.

Skin cancer rates are rising and earlier detection through screening leads to better outcomes. Health educators in community centers are well-situated to assess skin cancer risk, deliver tailored health information, and refer high-risk patients to a dermatologist for a screening. This study describes the evaluation of a brief, tailored skin cancer risk assessment, and referral intervention training. The training was developed as part of a pilot feasibility study and seven health educators were trained in an interactive session. Knowledge, attitudes, and efficacy were assessed before and after training. Health educators showed overall improvements of 22% in skin cancer risk knowledge, 50% improvement in positive attitudes toward assessment and referral, and a 40% increase in efficacy to intervene with patients. Community-based health educators that completed the training were able to successfully assess their patients for skin cancer risk and refer high-risk patients for a screening with a healthcare provider.

Health Educators in State/Local Public Health Departments: Training Needs and Awareness of Emerging Areas of Public Health Practice.

Although great progress has been made to define the field of health education and provide a voluntary certification system for professionals, research about the governmental health educator and health education specialist workforce is limited. The 2017 PH WINS (Public Health Workforce Interests and Needs Survey) provides valuable data on understanding the workforce demographics, attitudes, and training needs of governmental public health workers, including health educators, and informs future investments in workforce development efforts nationally. The purpose of this article is to examine demographics, job engagement and satisfaction, training needs, certification, and other characteristics of health educators and certified health education specialists (CHES) from PH WINS. We analyzed the data to describe the health educator workforce and compared it with the national governmental workforce across a range of variables. Compared with the national 2017 PH WINS sample, health educators were relatively younger, more ethnically diverse, more likely to be educated with an advanced degree, and were predominately employed in local versus state public health agencies. Health educators sampled were significantly more knowledgeable of all public health concepts compared with the national 2017 PH WINS respondent workforce. Comparison of CHES versus non-CHES professionals is also provided, along with practice and policy implications based on the data. This is the first detailed analyses of health educators in state and local health departments, with important findings and implications related to workforce composition, satisfaction, retention, and training. Further cross-sectional workforce research is needed to understand the current strengths and gaps in the health education workforce.

A mixed-methods study of the effectiveness and perceptions of a course design institute for health science educators.

BACKGROUND: Most health care professionals get their start in academics without formal teaching training. As such, institutions encourage participation in opportunities to address gaps in faculty's knowledge of pedagogy and learning theory in order to promote both successful student and patient outcomes. This study aimed to examine the reception of a faculty development program focused on teaching participants the basics of course design. METHODS: Applying a mixed-method approach, this retrospective study used pre/post-tests, assignment grades, self-assessment questionnaires, and focus groups to elucidate the impact of the faculty development intervention on course design. The participants (n = 12) were health educators from a private all-graduate level university with campus locations across the United States, including in the Southwest and Midwest. In the Course Design Institute (CDI), the participating faculty learned evidence-based instructional approaches and techniques to implement contemporary teaching practices. RESULTS: The data from the pre/post-tests and focus groups suggest that participants learned about topics including instructional alignment, learning goals and objectives, instructional strategies, assessment planning, feedback approaches, communicating expectations, and adult learning theories by participating in this course. The final deliverable scores indicate that the CDI graduates were able to apply a backward design process to plan their own instruction. Data from both the survey and the focus groups suggest that participants were satisfied with the experience and particularly appreciated that the course was relevant to them as educators in the health sciences. CONCLUSIONS: The results of this study indicate that the CDI was influential in developing the faculty's knowledge of the course design process, promoted the application of course design and pedagogy skills amongst CDI graduates, and positively impacted self-reported attitudes about their teaching abilities. In addition, feedback from participants indicates that they recognized the value of this program in their own development and they believed it should be a required course for all educators at the institution.

Reported Self-Efficacy of Health Educators During COVID-19.

The COVID-19 pandemic forced many public health professionals to take on new roles such as online teaching, communicating, and managing; serving on the frontlines of patient care; and serving as health education resource personnel. Researchers of this study posed the question: How has the pandemic impacted those who serve to help others? Seven aspects of self-efficacy in professional practice were examined via an online survey sent to health educators. Respondents were extremely confident communicating with their colleagues and supervisors (60%) and with students (51%), but only 19% were extremely confident in maintaining a work-life balance and 22% in managing personal and professional stress. Respondents reported being confident in all areas of responsibilities, overall, but they were most confident in Area 8 (ethics and professionalism) and least confident in Area 1 (assessing the needs and capacity of a community) since COVID-19. Findings imply a need for more professional development opportunities to foster professional and personal self-efficacy and to improve self-efficacy in needs assessment, leadership, and advocacy. Findings also show a need for workplace or state-based interventions to support resiliency and self-care among professionals who work to serve others.

Current and Emerging Trends in Diabetes Care and Education: 2021 National Practice and Workforce Survey.

PURPOSE: The purpose of the National Practice Survey is to understand current trends related to the diabetes care and education specialist's integration into the full care team beyond formal diabetes self-management education and support services. METHODS: The 2021 National Practice Survey (NPS2021) contained 61 questions for all respondents with an additional 56 questions pertaining to specific diabetes care and education segments. An anonymous survey was administered online to respondents who are diabetes care and education specialists or a part of the diabetes care team. Email lists were obtained from the Association of Diabetes Care & Education Specialists (ADCES) and the Certification Board for Diabetes Care and Education (CBDCE). Approximately 39,258 emails were sent, and 3357 were undeliverable, with 3797 surveys completed between February 9 to April 6, 2021, resulting in an 11% response rate. The response rate may have been affected by the COVID-19 public health emergency. RESULTS: Diabetes care and education specialists represent an interprofessional specialty of nurses, dietitians, physicians, pharmacists, health educators, and others. Many respondents reported holding either certification as a Certified Diabetes Care and Education Specialist (CDCES) or being Board Certified in Advanced Diabetes Management (BC-ADM). In addition, there appears to be a slight increase in those trained as a Lifestyle Coach to provide the National Diabetes Prevention Program (CDC Recognized National DPP) compared to NPS2017. Most respondents reported being Caucasian/White (84%), followed by Hispanic or Latinx (7%) and African American/Black and Asian/Asian American (at 4% each), like in previous surveys. Respondents reported diverse care delivery models, including traditional and nontraditional services, and expanded models of care such as population health/risk stratification models, the Chronic Care Model, Accountable Care Organizations, managed care, and others. CONCLUSION: The NPS2021 describes DCES workforce opportunities and challenges. Identifying and addressing those that impact the specialty's sustainability, diversity, and growth will guide strategies for the future workforce and their practice settings. Opportunities identified include embracing diabetes community care coordinators for person-centered delivery of care and education services and supporting frontline health care team members to increase competence and expertise in the prevention of type 2 diabetes, diabetes care, and education/support for related chronic diseases. In addition, as health care evolves, it creates opportunities for the DCESs to demonstrate a broader, key role as part of the diabetes care team.

Mindfulness and Understanding of Self-Care for Leaders of Extension: Promoting Well-Being for Health Educators and Their Clients.

Background: Mindfulness and self-care, practiced through a variety of methods like meditation and exercise, can improve overall sense of holistic well-being (i.e., flourishing). Increasing mindfulness and self-care may lead to increased flourishing and job satisfaction among the nation-wide Cooperative Extension system delivery personnel (agents) through a theory-based online program and an extended experiential program. Methods: Cooperative Extension agents from two states were invited to participate in MUSCLE via statewide listservs. Participants were invited to attend sessions and complete competency checks and between-session assignments each week. The study was conducted using Zoom. Pre- and post- program surveys included validated scales for flourishing and physical activity status. Due to high demand for mindfulness programing during the onset of the COVID-19 pandemic, experiential "Mindful Meet-up" 30-minute sessions were held on Zoom. Dissemination and implementation of the two differing interventions (i.e., MUSCLE and Mindful Meet-ups) were examined. Results: MUSCLE (more intensive program with assignments and competency checks) had lower reach, and did not show statistically increased flourishing or physical activity. Mindful Meet-ups had higher attendance and proportional reach during the beginning of the pandemic, but no practical measure of flourishing or physical activity behaviors. Unsolicited qualitative feedback was encouraging because the interventions were well-received and participants felt as though they were more mindful. Conclusions: While agents anecdotally reported personal improvements, capturing data on outcomes was challenging. Complementing outcome data with implementation and dissemination outcomes allowed for a richer picture to inform intervention decision-making (i.e., offering the same or new programming depending on participant needs).

Development and testing of an instrument to measure the collegiality competence of social and health care educators.

BACKGROUND: Previous studies have investigated the competence of social and health care educators from different perspectives. However, there has been little research on the collegiality competence of social and health educators. AIM / OBJECTIVE: The purpose of this study was to develop and psychometrically test a new collegiality competence instrument (CollegialityComp) designed to enable social and health care educators to self-evaluate their competence in collegiality. DESIGN: A cross-sectional study design for instrument development and psychometric testing. METHODS: Data were collected in the winter of 2020-2021 from social and health care educators at ten universities of applied sciences and ten vocational institutions in Finland (N = 1179), of whom 243 decided to participate. Face and content validity was assessed by seven experts, while structural validity and internal consistency were evaluated using exploratory factor analysis and Cronbach's alpha, respectively. RESULTS: The CollegialityComp development and testing process produced an instrument that includes 35 items representing five factors: (1) individual-centered collaboration, (2) educator action and fairness, (3) collaboration among colleagues, (4) collaboration outside the organization, and (5) communication and trust. CONCLUSION: The CollegialityComp instrument can be used to measure the collegiality competence of social and health care educators in the context of vocational and higher education. It may also be useful during the training of teacher candidates.

Collegiality among social- and health care educators in higher education or vocational institutions: A mixed-method systematic review.

BACKGROUND: Social- and health care educators collaborate on national and international levels; this collaboration is intrinsically related to collegiality, a concept which has only been scarcely studied among social- and health care educators. OBJECTIVES: To identify the best evidence on social- and health care educators' experiences of collegiality and factors influencing it in educational institutions. DESIGN: A mixed-methods systematic review. DATA SOURCES: Keywords were defined according to PICo and PEO inclusion and exclusion criteria. A search was performed across five databases (CINAHL, PubMed, Medic, Scopus, and ProQuest) for articles published in Finnish and/or English REVIEW METHODS: During the screening process, three researchers separately screened original studies by title and abstract (n = 806), and subsequently, based on the full-text (n = 40). The JBI Qualitative Assessment Research Instrument was used to evaluate qualitative studies, while the Critical Appraisal Checklist for Analytical Cross-sectional Studies was used to evaluate quantitative studies. RESULTS: The systematic review included a total of 15 articles. Collegiality among social- and health care educators was described through united and safe work culture, along with the dissemination of relevant expertise. The benefits of mentoring, communication on national and international levels, and collaboration are all issues that affect an educator's work. In the context of social- and health care educators, collegiality does not only include the interactions between the educators, but also involves their mentors and supervisors. Mentoring and collaboration between educational institutions were found to be associated with collegiality. CONCLUSIONS: Collegiality among educators can be maintained through networking, collaboration, mentoring, mutual communication and the consideration of professional ethical issues. It would be important for educational organisations to pay attention to collegiality and encourage educators to collaborate with their colleagues. It is important to emphasise the role of collegiality in the education of new social- and health care teacher candidates and the continuing education of current educators.

Health educators' professional agency in negotiating their problem-based learning (PBL) facilitator roles: Q study.

BACKGROUND: University educators are expected to cope with emerging situations and complex issues in teaching and learning, and this requires them to be agentic and proactive. While professional agency of health educators has not been investigated adequately, this study explores health educators' perception of their enactment of professional agency in the PBL facilitation process in a postpandemic context. METHODS: Forty PBL facilitators from medical and dental programs in Qatar University participated in the study during the fall semester of 2021, after resuming in-person PBL sessions. To collect and analyse data both qualitatively and quantitatively, Q methodology was employed. A 33-statement Q-set was established based on a proposed theoretical framework of professional agency in PBL facilitation, which included three dimensions-intrapersonal, action, and environment. RESULTS: Q factor analysis identified five significantly different viewpoints regarding how PBL facilitators perceive their professional agency sources, namely, (1) institutional resources, (2) policy guideline, (3) making efforts to improve support for students, (4) beliefs on PBL effectiveness, and (5) agentic actions. While four of the viewpoints were positive, participants with the second viewpoint reported negative perceptions and described lack of interest in facilitation work. All three dimensions of the framework were addressed and indicated complexity and interrelatedness of agency enactment. Consensus was observed regarding the need for more professional learning activities for faculty involved in PBL facilitation as source of professional agency. DISCUSSION: The results revealed a high variation of participants' perceptions of professional agency enactment throughout the three dimensions, indicating the need for establishing a common understanding of PBL facilitation work in a given context. For practical implications, further institutional efforts are required to support professional learning for PBL facilitation in a postpandemic context. Alternate approaches highlighting enforcement of agentic actions in all dimensions of intrapersonal values, stance and action taking, and active interactions with students, colleagues, and institutional environments are crucial. Q methodology provides new conceptual and empirical insights to explore the subjectivity of actors in health education.

Identification of the role of oral health educators in elementary schools during COVID-19 pandemic: a competency framework.

OBJECTIVE: Oral health educators should have the required knowledge, skills and attitude in order to meet the increased needs of the Ministry of Education in Syria as well as to perform their duties in promoting oral health in children appropriately during the COVID-19 pandemic. Therefore, this study was undertaken to identify core competencies required for oral health educators in elementary schools during the COVID-19 pandemic. Qualitative exploratory study was undertaken. A focus group which consisted of 5 Medical Education postgraduates and 3 oral health educators' training team members were invited to formulate a preliminary list of basic competencies. Delphi technique was also adopted through inviting 12 experts in oral health education to evaluate and formulate a final list of elementary schools' oral health educators' competencies during the COVID-19 pandemic. RESULTS: A competency framework was developed. Fifty-five competencies were identified including 35 in cognitive domain, 12 skills and 8 attitude competencies. A list of essential competencies has been identified. These competencies should be addressed in training programs targeting oral health educators, which can consequently produce competent educators who can successfully promote and provide health care to all schoolchildren during the COVID-19 pandemic.

Practical Advice Regarding the Reliability of the Patient Educational Materials Assessment Tool for Health Educators.

The quality of patient education materials is an important issue for health educators, clinicians, and community health workers. We describe a challenge achieving reliable scores between coders when using the Patient Educational Materials Assessment Tool (PEMAT) to evaluate farmworker health materials in spring 2020. Four coders were unable to achieve reliability after three attempts at coding calibration. Further investigation identified improvements to the PEMAT codebook and evidence of the difficulty of achieving traditional interrater reliability in the form of Krippendorff's alpha. Our solution was to use multiple raters and average ratings to achieve an acceptable score with an intraclass correlation coefficient. Practitioners using the PEMAT to evaluate materials should consider averaging the scores of multiple raters as PEMAT results otherwise may be highly sensitive to who is doing the rating. Not doing so may inadvertently result in the use of suboptimal patient education materials.

Health Educator Participation in Virtual Micro-Credentialing Increases Physical Activity in Public Health Competencies.

Background: Physical activity is an important component of leading a healthy life. Public health is one of the nine major sectors for disseminating information about physical activity and increasing the physical activity of the general public. Purpose: Increase competency among Cooperative Extension agents (i.e., public health workers) on selecting, delivering, and evaluating physical activity programs through a theory-based online training program. Methods: Cooperative Extension agents from two states were invited to participate via statewide listservs. Participants were invited to attend sessions, complete competency checks, and between-session assignments each week. The study was conducted using a video conferencing platform. The intervention was 9 weeks from June to July 2020 and had 130 participants. Pre- and post-program surveys included physical activity competencies and validated scales for flourishing and physical activity status. Data for competencies pre and post were analyzed using the Wilcoxon signed rank test, p < 0.01. Physical activity and flourishing pre and post were compared using t-tests, p < 0.05. Results: Physical activity in public health competency increased significantly (p < 0.00) as did agents' personal physical activity levels (p < 0.05). Changes in flourishing were not significant (p < 0.09) but trended in the hypothesized direction. Conclusions: The online competency-based training program significantly improved Cooperative Extension agents' knowledge of physical activity guidelines and physical activity program implementation. Future work is needed related to the scalability of the training program.