The Critical Role of Health Educators: Findings from the 2021 Public Health Workforce Interests and Needs Survey (PH WINS).

OBJECTIVE: This analysis of governmental health educators from the 2021 Public Health Workforce Interest and Needs Survey (PH WINS) examines demographic and workplace characteristics, COVID-19 pandemic activities and beliefs, job satisfaction, training needs, mental health, and engagement in health equity. SETTING AND PARTICIPANTS: Participants were public health staff in public health agencies who completed the 2021 PH WINS. DESIGN AND MAIN OUTCOME MEASURES: Chi-square and means tests were used to compare job satisfaction, mental health status, training needs, and health equity concepts between health educators and other disciplines in the governmental public health workforce. RESULTS: Like PH WINS 2017 findings, health educators were significantly younger, more likely to be female, more diverse, and more likely to work in regional/local health departments than the national governmental public health workforce. About 70% of health educators played a role in responding to the pandemic. Only 46.1% of health educators rated their mental health as excellent or very good as compared to 48.2% of other disciplines. About 31% considered leaving the organization due to stress, unsatisfactory opportunities, and lack of mentoring. Health educators expressed the need for training in financial and change management. Both health educators and other governmental workers expressed high levels of awareness of and confidence in addressing social determinants of health and health equity, but less confidence in addressing environmental justice. Certified health education specialists (CHES(R)) were significantly more likely to be aware of concepts of health equity, social determinants of health (SDOH), and structural racism than non-CHES(R). CONCLUSION: Overall, the training needs and job satisfaction of health educators changed little between the two surveys. However, COVID-19 had a significantly greater impact on their mental health status compared to other public health disciplines. They also are addressing racism in their communities and are more aware of health equity concepts than other public health disciplines. Implications for strengthening public health infrastructure, as well as recruitment/retention, professional preparation, and practice are provided.

Developing a Community-Based Research Project Proposal to Build Public Health Educator Capacity: A Graduate Student Perspective.

This article is the author's first-person perspective of completing an Applied Practice Experience (APE) at an accredited public health program. Graduate-level public health students in the United States are mandated by the Council on Education for Public Health to complete this supervised field experience to apply knowledge and concepts to real-world public health practice. For his APE, the author worked with a faculty advisor and two community groups to facilitate and submit a community-based participatory research grant proposal. This article discusses the author's experiences before, during, and after the APE. The author outlines challenges and success of working on this applied project. The article concludes with implications for public health education specialists regarding experiential learning and applied practice experiences for graduate students.

Public Policy Involvement by Certified Health Education Specialists: Results of a National Study.

BACKGROUND: Advocating for health-related activities is an essential part of being a health educator and knowing how to advocate is an important part of the Certified Health Education Specialist (CHES) exam. However, based on previous research, there may be a gap between knowing how to and actually participating in public policy activities. The purpose of this study was to determine public policy involvement of CHES. METHOD: Surveys were mailed to a random sample of 500 CHES (41% response rate). RESULTS: The highest selected public policy activities by CHES were the following: voting at an election (88.9%), contacting a public office (49%), and providing policy-related information (42.9%). The number of locations CHES individuals selected in having training on advocacy was a predictive factor in their confidence to perform advocacy. Positive correlations between perceived knowledge and effectiveness of the public policy process and self-reported involvement in public policy were found. CONCLUSION: Although there is moderate self-reported involvement in public policy activities, more emphasis needs to be placed on raising the confidence of CHES to perform advocacy-related activities in the field.

Health Education Specialists' Knowledge, Attitudes, and Perceptions of the Patient Protection and Affordable Care Act.

The changing landscape of health care as a result of the Patient Protection and Affordable Care Act (ACA) may provide new opportunities for health education specialists (HES). The purpose of this study was to survey HES in the United States on their knowledge and attitudes of the ACA and assess their perceptions of job growth under the law. A random sample of 220 (36% response rate) certified HES completed a 53-item cross sectional survey administered online through Qualtrics. Findings were compared to public opinion on health care reform. HES are highly favorable of the law (70%) compared to the general public (23%). A total of 85% of respondents were able to list a provision of the ACA, and most (81%) thought the ACA would be successful at increasing insured Americans. Over half (64.6%) believe job opportunities will increase. Those who viewed the law favorably were significantly more likely to score better on a knowledge scale related to the ACA. HES understand publicized provisions but are uncertain about common myths and specific provisions related to Title IV, "Prevention of Chronic Disease and Improving Public Health." Directed and continuing education to HES regarding the ACA is warranted.

Health Promotion in the Community: Impact of Faith-Based Lay Health Educators in Urban Neighborhoods.

Promoting wellness and providing reliable health information in the community present serious challenges. Lay health educators, also known as community health workers, may offer a cost-effective solution to such challenges. This is a retrospective observational study of graduates from the Lay Health Educator Program (LHEP) at Johns Hopkins Bayview Medical Center from 2013 to 2014. Students were enrolled from the surrounding community congregations and from the hospital's accredited clinical pastoral education program. There were 50 events implemented by the lay health educators during the 2014-2015 time period, reaching a total of 2004 individuals. The mean time from date of graduation from the LHEP to implementation of their first health promotional event was 196 ± 76 days. A significant number of lay health educators implemented events within the first year after completing their training. Ongoing monitoring of their community activity and the clinical impact of their efforts should be a priority for future studies.

The Lay Health Educator Program: Evaluating the Impact of this Community Health Initiative on the Medical Education of Resident Physicians.

Resident physicians receive little training designed to help them develop an understanding of the health literacy and health concerns of laypersons. The purpose of this study was to assess whether residents improve their understanding of health concerns of community members after participating in the Lay Health Educator Program, a health education program provided through a medical-religious community partnership. The impact was evaluated via pre-post surveys and open-ended responses. There was a statistically significant change in the residents' (n = 15) understanding of what the public values as important with respect to specific healthcare topics. Findings suggest participation in a brief, formal community engagement activity improved medical residents' confidence with community health education.

Effectiveness of a Web-based genomics training for health educators in Texas.

PURPOSE: With advanced genomic developments, better prevention strategies are available via personalized genomic services. Because there is a shortage of genetic professionals, and primary-care providers are overwhelmed with routine practice, involving health educators--whose expertise includes educating the general public and promoting healthy behavior--to provide basic genomics education may facilitate better services. We developed the first evidence- and theory-based family health history Web-based training for Texas health educators. This report presents its evaluation results. METHODS: Approximately one-third of Texas health educators holding (Master) Certified Health Education Specialist designation (~40% were racial/ethnic minorities) participated in the family health history Web-based training. Attitudes, self-efficacy, intention, knowledge, and practice were assessed at baseline, immediately after training, and 3 months posttraining. Qualitative data were collected to provide additional evaluation findings. RESULTS: Participants significantly improved their attitudes, knowledge, intention, and self-efficacy regarding family health history education, immediately posttraining and after 3 months. The number of participants practicing family health history was significantly increased. Participants' overall assessment of the program was positive. CONCLUSION: This family health history Web-based training successfully increased the number of genomically competent and culturally diverse Texas health educators. Ongoing efforts are needed to sustain and expand this education as well as to disseminate it to all health educators in the United States.

Using health educators to improve knowledge of healthy behaviour among Hajj 1432 (2011) pilgrims.

The main objective of this study was to assess the short-term effect on health knowledge among pilgrims after being provided specific health education messages. A random sample of 6 entry-point buses was selected. A self-administered questionnaire was used to assess knowledge before and after intervention; 278 pilgrims completed the questionnaire. There was a significant increase in the proportion of participants who answered all questions correctly after the educational intervention (P < 0.05). Almost all respondents stated that they benefited from the health education and that the health educator was successful in delivering the messages. Only 19 (7.2%) reported that they had already received relevant health education messages prior to their arrival in Saudi Arabia. Before the intervention just 50% of the respondents knew that safe shaving prevents dissemination of bloodborne diseases; this rose to 84.7% after the intervention. Direct health education to pilgrims is effective in improving short-term health knowledge.

Urban health educators' perspectives and practices regarding school nutrition education policies.

Although nutrition-related health education policies exist at national, state and local levels, the degree to which those policies affect the everyday practices of health education teachers who are charged with executing them in schools is often unclear. The purpose of this study was to examine the nutrition-related health education policy matrix that affected one urban school district, the health education teachers' awareness of those policies, the impact of nutrition policies on teachers' instruction and challenges teachers perceived in executing comprehensive nutrition education. The study used interpretive ethnography to examine the educational contexts and perspectives of 27 health educators from 24 middle schools in one urban district in the Midwestern United States. Data were collected through school observations, interviews with key personnel and document collection. We found that a network of nutrition-related education policies governed health education teachers' instruction, but that teachers were uniformly unaware of those policies. Without institutional coherence and clear directives, health education teachers taught little nutrition content, primarily due to poor training, professional development, instructional resources and administrative accountability. The results are discussed in light of the enormous challenges in many urban schools and the need for nutrition education professional development.

The educational and financial impact of using patient educators to teach introductory physical exam skills.

PURPOSE: Physical exam skills are essential to core competencies for physicians in training. It is increasingly difficult to secure time and funding for physician faculty to teach these critical skills. This study was designed to determine whether Patient Educators (PE) (non-physician instructors) in an introductory clinical medicine (ICM) course (1) were as effective as physician faculty in teaching the physical exam, (2) impacted consistency of student performance on a final practical exam, and (3) whether this model was cost effective. METHOD: PE were introduced into an ICM course at the University of Minnesota from 2006 to 2008. Each year, students' physical exam competencies were evaluated by a performance-based head-to-toe examination and 6 months later by an objective structured clinical examination (OSCE). Differences in test scores between years and variability (i.e., consistency) among yearly scores were assessed. The cost per student was calculated by considering a stable compensation cost per hour for the required number of physician faculty, standardized patients, and PE in each year. RESULTS: Mean student performance was statistically lower with PE, but only by two percentage points. The amount of variation within the medical student classes' physical exam skills remained stable as the use of PE expanded. Total educator salary costs per student declined from $449 in 2006 to $196 in 2008. CONCLUSIONS: In terms of sustainability and student performance, the use of trained lay educators has equivalent outcomes and is less costly for physical exam instruction in the pre-clinical years.

2017 National Standards for Diabetes Self-Management Education and Support.

PURPOSE: The purpose of this study is to review the literature for Diabetes Self-Management Education and Support (DSMES) to ensure the National Standards for DSMES (Standards) align with current evidence-based practices and utilization trends. METHODS: The 10 Standards were divided among 20 interdisciplinary workgroup members. Members searched the current research for diabetes education and support, behavioral health, clinical, health care environment, technical, reimbursement, and business practice for the strongest evidence that guided the Standards revision. RESULTS: Diabetes Self-Management Education and Support facilitates the knowledge, skills, and ability necessary for diabetes self-care as well as activities that assist a person in implementing and sustaining the behaviors needed to manage their condition on an ongoing basis. The evidence indicates that health care providers and people affected by diabetes are embracing technology, and this is having a positive impact of DSMES access, utilization, and outcomes. CONCLUSION: Quality DSMES continues to be a critical element of care for all people with diabetes. The DSMES services must be individualized and guided by the concerns, preferences, and needs of the person affected by diabetes. Even with the abundance of evidence supporting the benefits of DSMES, it continues to be underutilized, but as with other health care services, technology is changing the way DSMES is delivered and utilized with positive outcomes.

Cooperative Extension Gets Moving, but How? Exploration of Extension Health Educators' Sources and Channels for Information-Seeking Practices.

PURPOSE: The Cooperative Extension System (Extension) has implemented concerted efforts toward health promotion in communities across the nation by acting as an intermediary between communities and universities. Little is known about how these intermediaries communicate and learn about existing evidence-based programming. This study serves to explore this gap by learning about information sources and channels used within Extension. DESIGN: Sequential explanatory mixed methods approach. SETTING: National Cooperative Extension System. PARTICIPANTS: Extension community-based health educators. METHODS: A nationally distributed survey with follow-up semistructured interviews. Survey results were analyzed using a Kruskal-Wallis 1-way analysis of variance test paired with Bonferroni post hoc. Transcripts were analyzed by conventional content analysis. RESULTS: One hundred twenty-one Extension educators from 33 states responded to the survey, and 18 of 20 invited participants completed the interviews. Educators' information seeking existed in 2 forms: (1) information sources for learning about programming and (2) channels by which this information is communicated. Extension educators reported contacting health specialists and other educators. Extension educators also reported using technological means of communication such as e-mail and Internet to reach information sources such as peers, specialists, academic journals, and so on. CONCLUSION: Extension state specialists were preferred as primary sources for intervention information, and technology was acknowledged as an easy contact channel. This study identifies county-based health educators' information structures and justifies the need for future research on the role of specialists in communication efforts for educators.

Diabetes Healthcare Professionals Use Multiple Continuous Glucose Monitoring Data Indicators to Assess Glucose Management.

BACKGROUND: Continuous glucose monitoring (CGM) offers multiple data features that can be leveraged to assess glucose management. However, how diabetes healthcare professionals (HCPs) actually assess CGM data and the extent to which they agree in assessing glycemic management are not well understood. METHODS: We asked HCPs to assess ten de-identified CGM datasets (each spanning seven days) and rank order each day by relative glycemic management (from "best" to "worst"). We also asked HCPs to endorse features of CGM data that were important in making such assessments. RESULTS: In the study, 57 HCPs (29 endocrinologists; 28 diabetes educators) participated. Hypoglycemia and glycemic variance were endorsed by nearly all HCPs to be important (91% and 88%, respectively). Time in range and daily lows and highs were endorsed more frequently by educators (all Ps < .05). On average, HCPs endorsed 3.7 of eight data features. Overall, HCPs demonstrated agreement in ranking days by relative glycemic control (Kendall's W = .52, P < .001). Rankings were similar between endocrinologists and educators (R2 = .90, Cohen's kappa = .95, mean absolute error = .4 [all Ps < .05]; Mann-Whitney U = 41, P = .53). CONCLUSIONS: Consensus in the endorsement of certain data features and agreement in assessing glycemic management were observed. While some practice-specific differences in feature endorsement were found, no differences between educators and endocrinologists were observed in assessing glycemic management. Overall, HCPs tended to consider CGM data holistically, in alignment with published recommendations, and made converging assessments regardless of practice.

Barriers to adopting genomics into public health education: a mixed methods study.

PURPOSE: To examine public health educators' perceptions of barriers to incorporate genomic content (information, discoveries, technologies) into health promotion. METHODS: Mixed methods (qualitative and quantitative approaches)-using a fully mixed sequential dominant status design-were employed. Qualitative data were collected from a convenient sample of 24 public health educators, through personal interviews. Quantitative data, from a nation-wide sample of 1607 professionals (from four professional organizations/groups), were collected through a Web-based survey (adjusted response rate = 23.1%). Content analysis guided the interpretation of the qualitative data; descriptive statistics were used to analyze the survey data and to compare prevalence of themes across the qualitative and survey samples. RESULTS: Specific barriers highlighted by the qualitative and the survey samples included lack of genomic knowledge (basic and applied), having to deal with the lay public's reaction, lack of priority, time and resources, and incompatibility between genomics and public health educators' religious and ethical beliefs. CONCLUSION: This study suggests that public health educators perceive numerous barriers to incorporating genomics into health promotion. More research is needed to confirm this study's findings, to explore potential sources, and to propose viable strategies to overcome many of these barriers.

Similar 24-Hour Dietary Recall Results from Low-Income Women When Collected by a Paraprofessional Nutrition Educator or Registered Dietitian Nutritionist.

BACKGROUND: The Expanded Food and Nutrition Education Program (EFNEP) is a federally funded, community nutrition education program that assists the low-income population in acquiring knowledge and skills related to nutrition, food safety, food resource management, food security, and physical activity. Evaluation of EFNEP includes a 24-hour dietary recall (24HDR) administered by paraprofessional educators, yet protocols for most large-scale nutrition research studies employ registered dietitian nutritionists (RDNs) or individuals with educational backgrounds in nutrition or related fields to collect dietary recalls. OBJECTIVE: To compare 24HDRs collected by trained paraprofessional educators with recalls collected by an RDN. DESIGN: Exploratory cross-over study comparing same-day 24HDR in a one-on-one setting collected by paraprofessional educators and an RDN. Paired recalls were separated by at least 1 hour. PARTICIPANTS AND SETTING: The participants (n=41) were volunteer women who were eligible for participation in EFNEP in two states. MAIN OUTCOME MEASURES: The 24HDRs were compared for energy, macronutrients, micronutrients, and food groups. STATISTICAL ANALYSIS PERFORMED: Mixed-model analysis to account for repeated measures. Intraclass correlation and Spearman correlation coefficients to determine interrater agreement. RESULTS: No difference in 24HDR was seen when compared by interviewer (paraprofessional vs RDN) or by site (Colorado vs North Carolina). There were significant differences in four components (energy, total fat, saturated fat, and solid fats-added sugar) based on recall order, with a higher intake in the second recall compared with the first. CONCLUSION: The results of this preliminary study suggest that a well-trained paraprofessional educator using a valid methodology can collect a 24HDR that is similar to a recall collected by an RDN. The paraprofessional educator can be employed for dietary data collection, allowing the RDN to focus on more advanced aspects of scope of practice, such as data evaluation and program development.

Outcomes of a feasibility trial using an innovative mobile health programme to assist in insulin dose adjustment.

OBJECTIVE: Intensification of diabetes therapy with insulin is often delayed for people with suboptimal glycaemic control. This paper reports on the feasibility of using an innovative mobile health (mHealth) programme to assist a diabetes insulin dose adjustment (IDA) service. METHODS: Twenty adults with diabetes referred to a tertiary hospital IDA service were recruited. They were provided with a cloud-based mobile remote monitoring system-the mobile diabetes management system (MDMS). The credentialled diabetes educator (CDE) recorded the time taken to perform IDA utilising the MDMS versus the conventional method-which is a weekly adjustment of insulin doses by a CDE through telephone contact based on three or more daily blood glucose readings. Participants and staff completed a feedback questionnaire. RESULTS: The CDE spent 55% less time performing IDA using MDMS than using the conventional method. The participants were satisfied with MDMS use and the CDEs reported improved efficiency. CONCLUSION: Incorporating a mHealth programme for an IDA service has the potential to improve service delivery efficiencies while simultaneously improving the patient experience.

US health educators' likelihood of adopting genomic competencies into health promotion.

OBJECTIVES: We examined US health educators' likelihood of adopting genomic competencies--specific skills and knowledge in public health genomics--into health promotion and the factors influencing such likelihood. METHODS: We developed and tested a model to assess likelihood to adopt genomic competencies. Data from 1607 health educators nationwide were collected through a Web-based survey. The model was tested through structural equation modeling. RESULTS: Although participants in our study were not very likely to adopt genomic competencies into their practice, the data supported the proposed model. Awareness, attitudes, and self-efficacy significantly affected health educators' likelihood to incorporate genomic competencies. The model explained 60.3% of the variance in likelihood to incorporate genomic competencies. Participants' perceived compatibility between public health genomics and their professional and personal roles, their perceptions of genomics as complex, and the communication channels used to learn about public health genomics significantly related to genomic knowledge and attitudes. CONCLUSIONS: Because US health educators in our sample do not appear ready for their professional role in genomics, future research and public health work-force training are needed.

Innovative infrastructure in New Jersey: using health education professionals to inform and educate during a crisis.

Federal funding supports the growth and development of public health infrastructure and preparedness. The New Jersey Department of Health and Senior Services used federal funds to increase local public health infrastructure that included the hiring of health educators or risk communicators (HERCs). The HERCs are a diverse group of health and communications professionals trained in emergency communication. They provide crisis information regarding pubic health threats. Over the years, the role and duties of HERCs have expanded from bioterrorism to all-hazards approach and emerging infections public health preparedness, including pandemic influenza. This article describes how HERCs are used in the New Jersey public health infrastructure.

The 2017 Diabetes Educator and the Diabetes Self-Management Education National Practice Survey.

Purpose The American Association of Diabetes Educators conducts the National Practice Survey (NPS) biennially to document current practice in diabetes education in the United States. The purpose of the study is to obtain insight about factors influencing the work of the diabetes educator. Method The 2017 NPS was comprised of 100 questions covering diabetes educator demographics, profile populations of people with diabetes, practice information, program accreditation, program curriculum, staffing, education delivery methods, data collection, and reporting. The basic survey consisted of 22 questions using branch logic, from which respondents were then directed to questions tailored to their particular practice setting, enabling them to answer only a relevant subset of the remaining questions. The web-based survey was sent to approximately 32 000 individuals who were either members of the American Association of Diabetes Educators (AADE) or Certified Diabetes Educators (CDE) with the National Certification Board for Diabetes Educators (NCBDE) but not AADE members. Weekly reminder e-mails were sent to recipients who had not yet responded. The outreach efforts resulted in the survey being completed by 4696 individuals, a 17% response rate yielding 95% confidence that these responses are within ±5% accuracy. Results Diabetes Self-Management Education and Support (DSMES) continues to be a field dominated by women (95%). Diabetes educators represent a diverse health care profession, with educators indicating most commonly that their primary discipline is nursing (48%), nutrition (38%), and pharmacy (7%). When asked about credentials, 82.6% indicated that they held a CDE, 3.8% held the Board Certified-Advanced Diabetes Management (BC-ADM) credential, and 16.5% held neither the CDE nor the BC-ADM. Nearly 75% characterized their role as a diabetes educator as providing direct patient care. DSMES continued to be provided in a varied array of settings to educationally, socioeconomically, and racially diverse patient populations. DSMES was delivered using a number of different educational strategies. Diabetes educators have direct influence in care and services that people with diabetes receive. Conclusions The results of the 2017 NPS demonstrate that diabetes educators are meeting the needs of varied populations in various practice settings. They are working with individuals with type 1 and type 2 diabetes, those at risk for diabetes, and women with gestational diabetes and are involved in recommending, implementing, and providing key referrals and recommendations for diabetes care, including insulin initiation, titration, medication adjustments, recommendations on devices, and technology. Identified areas for improvement include needs for increased racial and ethnic diversity in the workforce, recruiting young professionals, drawing practice approaches from related disciplines (eg, mental health and disability rehabilitation), and encouraging tracking of more areas of outcomes data. Diabetes educators are playing an increasingly central role within multidisciplinary care teams with people at risk for diabetes, those who have diabetes, and those with other chronic conditions.

CDE Pharmacists in the United States.

Purpose The purpose of the study was to identify current practice settings for Certified Diabetes Educators (CDEs) who are pharmacists. Following nurses and dietitians, pharmacists are the third largest group of health professionals who hold the CDE credential. The growing number of CDE pharmacists highlights the increasing involvement of pharmacists in diabetes care. What remains unknown is the specific settings in which pharmacist CDEs practice. Methods A cross-sectional, nationwide electronic survey was sent to all CDE pharmacists in the United States. Questions regarding demographics, practice setting characteristics, certification information, and common diabetes-related counseling topics were asked of all respondents. Survey items also sought to determine pharmacists' perceptions of the benefits and barriers to obtaining the CDE credential. The questions were dichotomous, Likert-scale response, or open-ended. Results A total of 462 survey responses were included in the analysis for a response rate of (462/1275) 36.2%. Respondents identified hospital or health system as the most common practice setting (n = 311), followed by academia (n = 100), community (n = 81), managed care (n = 44), and other settings. Conclusions Study findings provide important data that describe where CDE pharmacists are practicing to provide diabetes education. The continued steady growth of CDE pharmacists suggests a consistent increase of pharmacists practicing diabetes education. Diabetes educators should recognize that CDE pharmacists practice in a variety of different settings.