Developing public health competency statements and frameworks: a scoping review and thematic analysis of approaches.

Competencies ensure public health students and professionals have the necessary knowledge, skills, values, and behaviours to do their jobs effectively. Public health is a dynamic and complex field requiring robust competency statements and frameworks that are regularly renewed. Many countries have public health competencies, but there has been no evidence synthesis on how these are developed. Our research aim was to synthesize the extent and nature of the literature on approaches and best practices for competencies statement and framework development in the context of public health, including identifying the relevant literature on approaches for developing competency statements and frameworks for public health students and professionals using a scoping review; and, synthesizing and describing approaches and best practices for developing public health competency statements and frameworks using a thematic analysis of the literature identified by the scoping review. We conducted a scoping review and thematic analysis of the academic and grey literature to synthesize and describe approaches and best practices for developing public health competency statements and frameworks. A systematic search of six databases uncovered 13 articles for inclusion. To scope the literature, articles were assessed for characteristics including study aim, design, methods, key results, gaps, and future research recommendations. Most included articles were peer-reviewed journal articles, used qualitative or mixed method design, and were focused on general, rather than specialist, public health practitioners. Thematic analysis resulted in the generation of six analytical themes that describe the multi-method approaches utilized in developing competency statements and frameworks including literature reviews, expert consultation, and consensus-building. There was variability in the transparency of competency framework development, with challenges balancing foundational and discipline-specific competencies. Governance, and intersectoral and interdisciplinary competency, are needed to address complex public health issues. Understanding approaches and best practices for competency statement and framework development will support future evidence-informed iterations of public health competencies.

Overview of the Health Communication Curriculum in Canadian Master of Public Health Programs.

CONTEXT: Competency-based public health education ensures practitioners are well equipped to positively influence the health of the public. The Public Health Agency of Canada's Core Competencies for Public Health has named communication as an essential competency area for practitioners. However, little is known about how Master of Public Health (MPH) programs in Canada support trainees in developing the recommended core competencies in communication. OBJECTIVE: Our research aims to provide an overview of the extent to which communication is embedded in the curriculum of MPH programs in Canada. DESIGN: We conducted an online scan of Canadian MPH course titles and descriptions to determine how many MPH programs offer communication-focused courses (ie, health communication), knowledge mobilization courses (eg, knowledge translation), and other courses that may support communication skills. Two researchers coded the data; discrepancies were resolved via discussion. RESULTS: Of the 19 MPH programs in Canada, less than half (n = 9) offer courses specifically focused on communication (ie, health communication); these courses are mandatory in only 4 programs. Seven programs offer knowledge mobilization courses; none are mandatory. Sixteen MPH programs offer a total of 63 other public health courses that are not focused on communication but contain communication terms (eg, marketing, literacy) in their course descriptions. No Canadian MPH program has a communication-focused stream or option. CONCLUSION: Canadian-trained MPH graduates may not be receiving sufficient communication training to equip them for effective and precise public health practice. This is particularly concerning, given that current events have underlined the importance of health, risk, and crisis communication.

A content analysis of Canadian influencer crisis messages on Instagram and the public's response during COVID-19.

Successful mitigation of emerging infectious disease requires that the public adopt recommended behaviours, which is directly influenced by effective crisis communication. Social media has become an important communication channel during COVID-19 where official actors, influencers, and the public are co-creating crisis messages. Our research examined COVID-19-related crisis messages across Canadian influencer accounts within news media, politicians, public health and government, science communicators, and brand influencer and celebrities, posted on Instagram between December 2019 and March 2021 for Health Belief Model and Extended Parallel Processing Model constructs and the corresponding public comment sentiment and engagement. Thirty-three influencer accounts resulted in a total of 2,642 Instagram posts collected, along with 461,436 comments, which showed overall low use of constructs in both captions and images. Further, most posts used no combinations (n = 0 or 1 construct per post) of constructs in captions and images and very infrequently used captions that combined threat (severity and susceptibility) with cues to action and efficacy. Brand influencers and celebrities, politicians, and science communicators had above average post engagement while public health and government and news media had lower. Finally, most influencers saw the largest proportion of neutral sentiment comments. Crisis messages must be designed to include combinations of constructs that increase message acceptance and influence risk perception and efficacy to increase the adoption of recommended and mandated behaviours.

A Review and Analysis of the Literature on Public Health Emergency Communication Practices.

A systematic review using structured and transparent methods was carried out to collect and review the qualitative literature investigating trust in crisis communication during emerging infectious diseases. Qualitative synthesis was conducted using a descriptive thematic analysis approach. The GRADE-CERQual assessment was used to determine the confidence in each thematic finding to support decisions when implementing review findings. Overall, 13 studies were included in the review, resulting in 10 thematic categories that describe characteristics associated with crisis communication information and sources of crisis communication that can enhance or maintain public trust. The results of this review suggest the public judges the trustworthiness of crisis communication based on the information characteristics, including consistency, repetition, and timeliness, and especially transparency and uncertainty. Public health is a trusted source of crisis communication when the presenting spokesperson is a health official, the information is not perceived as politicized, and is timely. Community leaders, such as family doctors, are also trusted sources of crisis communication, whereas media and government officials face distrust because of perceived sensationalized information, and defensiveness and unreliable information respectively. Qualitative data in this area is limited, especially involving the public and priority populations, and should be the focus of future research.

Developing competencies in public health: a scoping review of the literature on developing competency frameworks and student and workforce development.

Effective and precise public health practice relies on a skilled and interdisciplinary workforce equipped with integrated knowledge, values, skills, and behaviors as defined by competency frameworks. Competency frameworks inform academic and professional development training, support performance evaluation, and identify professional development needs. The aim of this research was to systematically identify and examine trends in the extent, nature, and range of the literature related to developing competencies in public health. This includes developing public health competency frameworks, and how competencies are developed and maintained in students and practitioners. We used a scoping review methodology to systematically identify and report on trends in the literature. Two independent reviewers conducted title and abstract and full-text screening to assess the literature for relevance. Articles were included if they were original primary research or gray literature and published in English. No date or geographic restrictions were applied. Articles were included if they focused on developing competency statements or frameworks for public health and/or training public health students or practitioners to develop competencies. The review encompassed a range of methods and target populations, with an emphasis on building competencies through student and professional development. Foundational competency development was a primary focus, and we found a gap in discipline-specific competency research, especially within developing discipline-specific competency statements and frameworks. Several evidence-based practices for competency development were highlighted, including the importance of governance and resources to oversee competency framework development and implementation, and workforce planning. Experiential learning and competency-based training were commonly identified as best practices for building competencies. A comprehensive understanding of public health competency development-through developing and incorporating foundational and discipline-specific competencies, mapping student and practitioner training to competency frameworks, and incorporating best practices-will enable public health to create skills and an adaptable workforce capable of addressing complex public health issues.

Modernizing public health communication competencies in Canada: A survey of the Canadian public health workforce.

OBJECTIVES: Since the publication of the Core Competencies for Public Health in Canada in 2008, the public health and communication landscape has changed dramatically. Digital media and infodemics have shifted how practitioners must communicate and respond to health information. The age of the current competency framework, which is relied on for workforce development, alongside emerging public health challenges, have prompted calls for modernized competency statements. This study aims to (i) measure self-reported communication competence in the public health workforce, (ii) measure agreement with new communication competency statements, (iii) identify variation in agreement between sub-groups of professionals, and (iv) explore current and needed communication training. METHODS: Using a mixed-methods online survey, a sample of 378 participants in various Canadian public health roles and regions were asked to rate their current communication competence and agreement with a modernized, evidence-based draft communication competency framework. The survey was distributed in both official languages through partner organizations and social media. Descriptive statistics were performed to assess agreement and variation was analyzed in relation to public health roles and experience. RESULTS: While most participants self-reported communication competence, specific areas were rated lower. All 21 proposed competency statements received high agreement with some variation observed between expertise and experience levels. Demand for communication training is high. CONCLUSION: Strong agreement with statements indicates support for a modernized communication competency framework among sampled professionals. Research to gather more evidence surrounding the communication demands of the public health workforce and observed variation in strong agreement for the proposed statements is underway.

RéSUMé: OBJECTIFS: Depuis la publication des Compétences essentielles en santé publique au Canada en 2008, le paysage de la santé publique et des communications a radicalement changé. Les médias numériques et l'infodémie ont fait évoluer les façons dont les praticiennes et les praticiens doivent communiquer les informations sur la santé et y réagir. L'âge du cadre de compétences actuel et son importance pour le développement de la main-d'œuvre, en plus des problèmes de santé publique émergents, suscitent des appels à moderniser les énoncés de compétences. Notre étude vise à : i) mesurer la compétence en communication autodéclarée dans la main-d'œuvre en santé publique, ii) mesurer l'accord avec de nouveaux énoncés de compétences en communication, iii) déterminer si les sous-groupes professionnels diffèrent dans leurs niveaux d'accord et iv) explorer la formation en communication actuelle et celle qui serait nécessaire. MéTHODE: À l'aide d'un sondage en ligne à méthodes mixtes, nous avons demandé à un échantillon de 378 personnes exerçant divers rôles en santé publique dans diverses régions du Canada d'évaluer leur compétence en communication actuelle et leur accord avec un projet de cadre de compétence en communication modernisé, fondé sur les données probantes. Le sondage a été diffusé dans les deux langues officielles par des organismes partenaires et dans les médias sociaux. Nous avons effectué une analyse statistique descriptive pour évaluer le niveau d'accord, et nous avons analysé les écarts par rapport aux rôles et à l'expérience en santé publique. RéSULTATS: La plupart des personnes participantes se sont dites compétentes en communication, mais certains aspects ont obtenu des notes plus faibles. Les 21 énoncés de compétences proposés ont été bien acceptés, avec quelques écarts observés entre le savoir-faire et les niveaux d'expérience. La demande de formation en communication est élevée. CONCLUSION: L'accord général avec les énoncés est signe de l'appui à un cadre de compétence en communication modernisé chez le personnel professionnel de notre échantillon. Une étude est en cours pour réunir d'autres éléments probants sur les demandes de la main-d'œuvre en santé publique en matière de communication et sur les écarts observés dans l'accord général avec les énoncés proposés.

Public health communication professional development opportunities and alignment with core competencies: an environmental scan and content analysis. / Offres de perfectionnement professionnel en communication en santé publique et correspondance avec les compétences essentielles : analyse contextuelle et analyse de contenu.

INTRODUCTION: Communication is vital for effective and precise public health practice. The limited formal educational opportunities in health communication render professional development opportunities especially important. Competencies for public health communication describe the integrated knowledge, values, skills and behaviours required for practitioner and organizational performance. Many countries consider communication a core public health competency and use communication competencies in workforce planning and development. METHODS: We conducted an environmental scan and content analysis to determine the availability of public health communication professional development opportunities in Canada and the extent to which they support communication-related core competencies. Three relevant competency frameworks were used to assess the degree to which professional development offerings supported communication competency development. RESULTS: Overall, 45 professional development offerings were included: 16 "formalized offerings" (training opportunities such as courses, webinars, certificate programs) and 29 "materials and tools" (resources such as toolkits, guidebooks). The formalized offerings addressed 25% to 100% of the communication competencies, and the materials and tools addressed 67% to 100%. Addressing misinformation and disinformation, using current technology and communicating with diverse populations are areas in need of improved professional development. CONCLUSION: There is a significant gap in public health communication formalized offerings in Canada and many of the materials and tools are outdated. Public health communication professional development offerings lack coordination and do not provide comprehensive coverage across the communication competencies, limiting their utility to strengthen the public health workforce. More, and more comprehensive, professional development offerings are needed.

Credibility of vaccine-related content on Twitter during COVID-19 pandemic.

During national COVID-19 vaccine campaigns, people continuously engaged on Twitter to receive updates on the latest public health information, and to discuss and share their experiences. During this time, the spread of misinformation was widespread, which threatened the uptake of vaccines. It is therefore critical to understand the reasons behind vaccine misinformation and strategies to mitigate it. The current research aimed to understand the content of misleading tweets and the characteristics of their corresponding accounts. We performed a machine learning approach to identify misinformation in vaccine-related tweets, and calculated the demographic, engagement metrics and bot-like activities of corresponding accounts. We found critical periods where high amounts of misinformation coincided with important vaccine announcements, such as emergency approvals of vaccines. Moreover, we found Asian countries had a lower percentage of misinformation shared compared to Europe and North America. Our results showed accounts spreading misinformation had an overall 10% greater likelihood of bot activity and 15% more astroturf bot activity than accounts spreading accurate information. Furthermore, we found that accounts spreading misinformation had five times fewer followers and three times fewer verified badges than fact-sharing accounts. The findings of this study may help authorities to develop strategies to fight COVID-19 vaccine misinformation and improve vaccine uptake.

Trust and Engagement on Twitter During the Management of COVID-19 Pandemic: The Effect of Gender and Position.

During the COVID-19 pandemic, health and political leaders have attempted to update citizens using Twitter. Here, we examined the difference between environments that social media has provided for male/female or health/political leaders to interact with people during the COVID-19 pandemic. The comparison was made based on the content of posts and public responses to those posts as well as user-level and post-level metrics. Our findings suggest that although health officers and female leaders generated more contents on Twitter, political leaders and male authorities were more active in building networks. Offensive language was used more frequently toward males than females and toward political leaders than health leaders. The public also used more appreciation keywords toward health leaders than politicians, while more judgmental and economy-related keywords were used toward politicians. Overall, depending on the gender and position of leaders, Twitter provided them with different environments to communicate and manage the pandemic.

A qualitative study exploring healthcare providers' and trainees' barriers to COVID-19 and influenza vaccine uptake.

Background: Vaccines are effective biological interventions which reduce health burdens and protect healthcare providers from vaccine-preventable diseases. However, there are concerns about varying levels of vaccination coverage of influenza and COVID-19 vaccines among those working in healthcare. The aim of this study was to identify barriers and facilitators to COVID-19 and influenza vaccinations among healthcare providers and trainees using the Theoretical Domains Framework (TDF). Methods: Semi-structured interviews (n = 18) were carried out with healthcare providers and trainees in Canada. A thematic analysis approach was used to code interview transcripts and match findings to TDF domains and broader categories. Results: Three overarching themes were generated from six TDF domains and three inductively generated categories: (1) making informed health decisions with an added responsibility to protect oneself and patients; (2) a pro-vaccine social network, widespread accessibility, and pursuing a sense of normalcy; and (3) seeking a more nuanced, respectful, and calculated approach to vaccine communication and policy implementation. Conclusion: These findings help to identify factors associated with influenza and COVID-19 vaccine uptake among individuals in the healthcare field. Addressing these factors may improve healthcare provider sentiments surrounding vaccines, lead to better patient education, and increased uptake of vaccinations with the potential for seasonal booster doses.

Canadian COVID-19 Crisis Communication on Twitter: Mixed Methods Research Examining Tweets from Government, Politicians, and Public Health for Crisis Communication Guiding Principles and Tweet Engagement.

To foster trust on social media during a crisis, messages should implement key guiding principles, including call to action, clarity, conversational tone, compassion and empathy, correction of misinformation, and transparency. This study describes how crisis actors used guiding principles in COVID-19 tweets, and how the use of these guiding principles relates to tweet engagement. Original, English language tweets from 10 federal level government, politician, and public health Twitter accounts were collected between 11 March 2020 and 25 January 2021 (n = 6053). A 60% random sample was taken (n = 3633), and the tweets were analyzed for guiding principles. A tweet engagement score was calculated for each tweet and logistic regression analyses were conducted to model the relationship between guiding principles and tweet engagement. Overall, the use of guiding principles was low and inconsistent. Tweets that were written with compassion and empathy, or conversational tone were associated with greater odds of having higher tweet engagement. Across all guiding principles, tweets from politicians and public health were associated with greater odds of having higher tweet engagement. Using a combination of guiding principles was associated with greater odds of having higher tweet engagement. Crisis actors should consistently use relevant guiding principles in crisis communication messages to improve message engagement.

Examining Social Media Crisis Communication during Early COVID-19 from Public Health and News Media for Quality, Content, and Corresponding Public Sentiment.

Rising COVID-19 cases in Canada in early 2021, coupled with pervasive mis- and disinformation, demonstrate the critical relationship between effective crisis communication, trust, and risk protective measure adherence by the public. Trust in crisis communication is affected by the communication's characteristics including transparency, timeliness, empathy, and clarity, as well as the source and communication channels used. Crisis communication occurs in a rhetorical arena where various actors, including public health, news media, and the public, are co-producing and responding to messages. Rhetorical arenas must be monitored to assess the acceptance of messaging. The quality and content of Canadian public health and news media crisis communication on Facebook were evaluated to understand the use of key guiding principles of effective crisis communication, the focus of the communication, and subsequent public emotional response to included posts. Four hundred and thirty-eight posts and 26,774 anonymized comments were collected and analyzed. Overall, the guiding principles for effective crisis communication were inconsistently applied and combined. A limited combination of guiding principles, especially those that demonstrate trustworthiness, was likely driving the negative sentiment uncovered in the comments. Public health and news media should use the guiding principles consistently to increase positive sentiment and build trust among followers.

Developmental Milestones and Quality of Life Assessment in a Congenital Myotonic Dystrophy Cohort.

BACKGROUND: Congenital myotonic dystrophy (CDM) is a neuromuscular disorder caused by a CTG triplet repeat expansion in the DMPK gene. In addition to the expected motor delay, affected children often have significant developmental disability in language and cognitive realms, which ultimately impacts on quality of life. OBJECTIVE: In a prospective cohort of children with CDM to 1) present the profile of language and motor developmental milestones, and 2) describe their early childhood health related quality of life (HRQOL). METHODS: A five year cohort study of eligible incident cases of CDM was performed via the Canadian Pediatric Surveillance Program (CPSP). Consenting subjects were then followed from infancy in a prospective cohort study. Caregivers were contacted every 3 months for the first year of life, and then twice yearly in order to obtain data concerning language skills, motor development and parent proxy HRQOL from the PedsQL and Infant and Toddler Quality of life (ITQOL) questionnaires. RESULTS: Milestones were achieved at later ages in patients when compared to healthy children. Girls appeared to be more delayed than boys in both language and motor skills. HRQOL scores remained stable in this cohort, for both the PedsQL and ITQOL. CONCLUSIONS: Understanding developmental milestones and quality of life are important parameters when judging a child's overall health. For CDM patients delineating developmental milestones and QOL have important clinical care and research implications.