Using a 'rich picture' to facilitate systems thinking in research coproduction.

BACKGROUND: In coproduction research, traditional 'end-users' are involved in the entire research process. The aim is to facilitate research translation by improving the timeliness and relevance of research. Because end-users often come from multiple sectors and hold diverse perspectives and priorities, involving them in coproduction can be challenging. Tools and approaches are needed to support coproduction teams to successfully navigate divergent viewpoints while producing rigorous but meaningful research outcomes. Rich pictures are a systems thinking tool to help make sense of complexity. In this paper, we describe how we developed and applied a 'rich picture' in a coproduction project with policy-level partners. METHODS: Guided by systems thinking principles, we conducted a systemic analysis of ethnographic fieldnotes collected as part of a broader study that examined the dynamics between an IT system and the implementation of the state-wide childhood obesity prevention programmes it was designed to monitor. Translating qualitative themes into metaphor and imagery, we created a visual depiction of the system to reflect the experience of the system's users (health promotion practitioners) and facilitated a workshop with policy-level programme administrators (i.e. participants, n = 7). Our aim was to increase the transparency of the system for our research partners and to spark new insights to improve the quality of programme implementation. RESULTS: Guided by provocative questions, participants discussed and challenged each other's thinking on the current functioning of the system. They identified future lines of inquiry to explore for quality improvement. Participants strongly agreed that the picture was a constructive way to engage with the ethnographic data but were challenged by the information and its implications. The opportunity for participants to co-learn from each other as well as from the picture was an added value. CONCLUSION: In the context of the facilitated workshop, the rich picture enabled research partners to engage with complex research findings and gain new insights. Its value was harnessed via the guided participatory process. This demonstrates the importance that, in the future, such tools should be accompanied by practices that enable participants to think with and apply systems thinking concepts and principles.

Health Advocacy for Busy Professionals: Effective Advocacy With Little Time.

Health advocacy is a central responsibility for health educators and public health practitioners, as documented clearly in our professional competencies. Professional organizations such as the Society for Public Health Education and the American Public Health Association undertake frequent advocacy initiatives and strive to engage their members in advocacy strategies on a regular basis. Despite this understanding and advocacy training requirements in academic preparation programs for public health professionals, students and emerging professionals often lack advocacy experience. In this article, we provide descriptions of multiple effective health advocacy strategies spread across the time intensity spectrum, in order of least time intensive to most. Advocates may select the best strategy based on the needs of their target audience, the amount of time and energy they have for the task, and the level of confidence they have in practicing the strategy itself.

Public Health and School Health Education: Aligning Forces for Change.

The interdependent relationship between health and education has long been documented by leading health and education scholars. Children who are not physically, mentally, socially, or emotionally healthy will not be ready to learn and thus hampered to achieve their full potential as productive members of society. Despite this evidence, the United States has yet to bridge the divide between the health and education systems. This perspective introduces three manuscripts in this Special School Health Education Collection on the future of school health education in the United States, and provides a context for the challenges and recommendations each article outlines to improve the quantity and quality of school health education for preK-12 youth. Although some of the challenges and recommendations are not novel, what is exciting is the opportunity to move the agenda forward given the Whole School, Whole Community, Whole Child model and the Every Student Succeeds Act of 2015. Aligning the forces of public health and school health educators is essential to make school health education a societal imperative.

The challenges of becoming better sex educators for young people and the resources needed to get there: findings from focus groups with economically disadvantaged ethnic/racial minority parents.

The benefits of positive parent-adolescent relationships and effective communication on sexual risk have been demonstrated among minority parents and teenagers. However, there is need for illuminating how structural inequalities, such as economic disadvantage and being an ethnic/racial minority, shape parents' approaches to adolescent sexuality. Schalet's cultural framework describes White middle-income Dutch parents' 'normalization' (i.e. support for self-regulated sexuality, healthy relationships and normalization of teenage sexuality) versus White middle-income American parents' 'dramatization' (i.e. emphasis on raging hormones, battle between the sexes and pushing sex outside the home) of teenage sexuality, approaches which she argues contribute to differences in sexual health outcomes in the two countries. We adopt Schalet's framework to explore the approaches of 182 economically disadvantaged ethnic/racial minority parents attending 1 of 15 focus groups across New York State. The results revealed parents' dramatization of teenage sexuality, and how fears about their children's health and safety combined with a lack of resources and educational tools heightened this dramatization process. Yet parents identified communication skills and community resources to help them normalize teenage sexuality. The findings have the potential to inform policy makers and practitioners working to develop programs and policies to bolster parents' role as effective sex educators for adolescents.

Serving Those That Serve.

Since 1986, health promotion has had a place within the U.S. Department of Defense. Emphasizing the leading health indicators of Healthy People, the role of health promotion has continued to support the U.S. Armed Forces in perhaps one of the most challenging decades of wartime operations. Serving a sizable population with both typical and mission-related health issues, health promotion plays a critical role in maintaining and improving health. The purpose of this article is to highlight military health promotion by offering insight into the day-to-day life of a "boots on the ground" military health educator, reviewing the challenges and opportunities of working with a unique population. A summary of a variety of military specific initiatives is provided. Additionally, the article highlights the barriers and benefits to military health promotion. Last, the article concludes with a call to action to consider the role of all health educators in serving those that serve.

Advocacy and Public Policy Perceptions and Involvement of Master Certified Health Education Specialists.

Master Certified Health Education Specialists (MCHES; n = 186) participated in a mail survey on advocacy and public policy. Over half of participants reported that they had contacted a public official or provided policy-related information to consumers or other professionals. Participants identified barriers and benefits to influencing public policy. The greatest benefit was identified as improving the health or welfare of the public while the greatest barrier was that they were busy with other priorities. Participants also described their level of involvement, knowledge, training in advocacy, and their self-efficacy in performing various advocacy activities. Most MCHES reported voting and other basic advocacy functions while far fewer had participated in more advanced advocacy activities. Although nearly 73% had formal training on advocacy and policy, only 26% received it through college coursework. Factors predictive of advocacy and policy involvement were determined through a stepwise regression analysis. Five independent variables predicted the total number of advocacy activities and when combined accounted for nearly 61% of the variance. Government-level health educators' misconception that they cannot participate in advocacy and public policy issues should be dispelled. Health education specialists with the MCHES credential need coursework and additional training on how to effectively influence public health policy.

Health Education Careers in a Post-Health Reform Era.

Since enactment of the Patient Protection and Affordable Care Act in 2010, health education specialists (HES) have made important contributions in implementing the law's provisions at the individual, family, and population levels. Using their health education competencies and subcompetencies, HES are improving public understanding of health insurance literacy and enrollment options, conducting community health needs assessments required of nonprofit hospitals, modifying policies or systems to improve access to health screenings and preventive health services, strengthening clinical and community linkages, and working with employee benefit plans. In addition to educating stakeholders about their complementary training and roles with respect to clinical providers, HES must keep abreast of rapid changes catalyzed by the Affordable Care Act in terms of health standards, payment models, government regulations, statistics, and business practices. For continued career growth, HES must continually acquire new knowledge and skills, access and analyze data, and develop interprofessional partnerships that meet the evolving needs of employers as the nation pursues health for all.

[A professional identity rooted in public health]. / Une identité professionnelle ancrée dans la santé publique.

Marie-Sophie Cherillat was trained by managers well versed in the issues surrounding public healthcare. She focuses her practice on the health determinants specific to each individual patient and is committed to therapeutic education.

Reducing Premature Mortality in the Mentally Ill Through Health Promotion Programs.

Nearly half of the U.S. adult population will have a major mental illness during their lifetimes. At any point in time, almost a fifth of all American adults have a serious mental illness (SMI). Too many in our society do not understand mental illnesses, placing the blame for the illness on those with the illness, resulting in isolation, marginalization, or incarceration of individuals with SMIs. They may experience stigma, inadequate and delayed health and mental health care, and major socioeconomic disadvantages. They may struggle with activities of daily living, lose many of their resources, and spiral down into poverty. The disadvantages and decreased ability to function experienced by individuals with SMIs lead to increased unhealthy behaviors, reduced participation in wellness-related activities, and premature morbidity and mortality. The general and physical health of individuals with SMIs poses greater challenges from both practice and research standpoints. However, health educators are poised uniquely to provide health promotion programs, conduct research, and advocate for the health and well-being of individuals with SMIs. In this review, we summarize the challenges and opportunities for health promotion in individuals with SMIs.

Willingness of Australian health educators and health promotion officers to conduct rapid HIV testing.

Issue addressed: Rapid HIV tests were recently approved by the Australian government. This paper examines the attitudes and willingness to conduct rapid HIV testing (RHT) of Australian health educators and health promotion officers (HE/HPO) from various settings and disciplines.Methods: The aim of the Promoting Research on Methods in Screening Expertise study was to explore knowledge of HIV, attitudes towards people living with HIV, and willingness to conduct RHT among HE/HPO in Australia; this information was attained via an online survey of HE/HPO. Descriptive statistics, χ2 tests, t-tests, and multivariate logistic regression were then conducted.Results: Data from 156 HE/HPOs were analysed. Overall, 60% of participants believed that HE/HPO should offer RHT. Additionally, 70% were personally willing to undergo training in conducting RHT. Fifty-nine percent of participants scored as having 'high' HIV knowledge (at least 12 out of 13 correct answers), with 32% answering all questions correctly. Knowledge was strongly associated with willingness to be trained to conduct RHT.Conclusions: HE/HPO with advanced training in developing evidence-based approaches to improve the health and wellbeing of marginalised and disadvantaged groups may be an appropriate workforce to train to conduct RHT and counselling.So what?: As government agencies and community-based organisations plan to expand RHT, HE/HPO, including those who work outside of sexual health, should be considered as a viable workforce to upskill.

Professional development--not just for our learners.

Professional development is important for nurse educators. This article describes the experiences of three professional development nurses as they engaged in their own learning over the past year.

Readability of menopause web sites: a cross-sectional study.

More women are frequently referring to the Internet for health information, yet the readability of information about menopause on the Internet has not been widely studied. To address this gap, this study examined the readability of information about menopause on 25 Internet Web sites. Findings included that information on the Web sites had a reading level higher than the recommended sixth-grade level, and culturally appropriate health information was lacking. Health educators and practitioners are in a pivotal role to help women understand information useful for healthcare decisions. Several criteria are discussed to help practitioners evaluate Web sites.

Professionalization and the experience-based expert: strengthening partnerships between health educators and community health workers.

The recent inclusion of community health workers (CHWs) in the U.S. Department of Labor's 2010 Standard Occupational Classification System provides an opportunity for health educators to reflect on their relationship with CHWs. The authors discuss the ways that health educators and CHWs differ in their orientation toward professionalization and employ the concept of the "experience-based expert" to highlight what they believe to be the unique contributions of CHWs. Finally, considerations important for health educators and CHWs as they work to advance supportive and complementary practices are discussed.

Texas health educators' practice in basic genomics education and services.

Background: Health educators (HEs), who are specialized in health education, can provide basic genomics education/services to the public. Such practice of HEs is unknown. We examined HEs' genomics knowledge and practice, intention, attitudes, self-efficacy and perceived barriers in providing basic genomics education/services. Materials & methods: Texas HEs (n = 662) were invited to complete the survey that was developed based on theoretical constructs (i.e., practice/behavior, intention, attitudes, self-efficacy, knowledge and perceived barriers) from various health behavior theories. Results: Among 182 HEs completed the survey, most had never/seldom provided basic genomics education/services. Participants' practice was positively associated with their intention in performing basic genomics education/services and previous genomics training. Intention to offer such education/services was positively related to HEs' self-efficacy and attitudes, which were correlated to previous genomics training. Conclusion: Texas HEs lacked basic genomics education/services practice. As previous genomics training was associated with HEs' practice, providing continuing education may enhance their practice.

Park rangers as public health educators: the Public Health in the Parks Grants Initiative.

Health education in nontraditional settings can supplement messages received in more traditional venues, such as schools and health care facilities, and can reach new populations. In 2007, the US National Park Service awarded one-time seed grants of $10 000 or less to 16 parks in 16 states to fund the development of public health-focused programs for visitors. These programs used a wide variety of formats and addressed topics such as air pollution, prevention of vector-borne diseases, and promotion of physical activity in the parks. Almost 12 000 visitors attended the programs in 2007. Most programs were supported by park management and were well received by visitors. National parks and similar settings may be underutilized resources for delivering health messages to the general population.

The patient-centered medical home and why it matters to health educators.

The Patient-Centered Medical Home (PCMH) is an approach to providing comprehensive care for children, youth, and adults in the primary care setting. PCMH emphasizes planned care, care coordination, family-centered approaches, and quality of care while also improving access to care and modernizing the care experience. Although health educators as a group have not traditionally focused their efforts on the primary care setting, the PCMH model increases the potential for their inclusion. Health educators, given their training and expertise, are likely to be well positioned to contribute to primary care oriented with a PCMH model. Health educator roles within PCMH that are especially relevant include participating in a team approach to care, attention to coordination and integration of care, and preventive and end-of-life care. Such roles may be realized in direct delivery of patient education such as health coaching, serving as a facilitator or connector to community resources, or involvement in practice or practice organization quality improvement and population-based assessment efforts. If implemented properly, the involvement of health educators in this new model of care has the potential to enhance how primary care is delivered, improve the health of Americans with regard to chronic conditions, and reduce related health care costs.

COPD-Specific Self-Management Support Provided by Trained Educators in Everyday Practice is Associated with Improved Quality of Life, Health-Directed Behaviors, and Skill and Technique Acquisition: A Convergent Embedded Mixed-Methods Study.

BACKGROUND: There is a necessity to better document the effect of continuing education activities targeted at respiratory educators providing self-management support for patients with chronic obstructive pulmonary disease (COPD). We therefore sought to describe real-life COPD-specific self-management support delivered by respiratory educators who participated in a lecture-based continuing education activity and assess the outcomes of patients with COPD. METHODS: We conducted a convergent embedded mixed-methods study. Respiratory educators attended a 7-h, lecture-based continuing education activity on self-management support held in Québec, Canada. Four months after the continuing education activity, in their professional practice, trained educators provided self-management support to patients with COPD. One month later, to describe the components of self-management support provided, individual telephone interviews were conducted with educators. Interviews were transcribed verbatim and were qualitatively analyzed. Before self-management support and 6 months afterwards, we assessed the following clinical outcomes of patients with COPD: (1) quality of life (St. George's Respiratory Questionnaire for COPD patients, Impact domain; score 0-100; minimal clinically important difference = - 4; telephone administered); (2a) whether patients had one or more unscheduled doctor visit, (2b) one or more emergency room visit, and (2c) one or more hospitalization in the 6 preceding months (Survey on Living with Chronic Diseases in Canada; telephone administered); and (3a) health-directed behaviors and (3b) skill and technique acquisition (Health Education Impact Questionnaire; score 1-4; self-administered at home). We used mixed models to estimate mean differences and prevalence ratios, with associated 95% confidence intervals. RESULTS: Trained respiratory educators (nurse: n = 1; respiratory therapist: n = 3; ≥ 15 years of experience of care with patients with chronic disease) invited 75 patients with COPD to participate in the study. Fifty-four individuals with COPD (age, mean ± standard deviation: 68 ± 8 years; men: n = 31) were enrolled and received self-management support. Qualitative analyses revealed that self-management support consisted of one to two visits that included: (1) provision of information on COPD; (2) training in inhalation technique; and (3) smoking cessation advice. No educator reported implementing two or more follow-up visits because of a lack of time and human resources in their work setting. Among patients with COPD, improvements in quality of life were clinically important (adjusted mean difference = - 12.75; 95% confidence interval - 18.79 to - 6.71; p = 0.0001). Health-resource utilization was not different over time (all p values > 0.05). Improvements in health-directed behaviors and skill and technique acquisition were statistically significant (health-directed behaviors: adjusted mean difference = 0.50; 95% confidence interval 0.23-0.77; p = 0.0005; skill and technique acquisition: adjusted mean difference = 0.12; 95% confidence interval 0.01-0.23; p = 0.0293). CONCLUSIONS: Following a 7-h, lecture-based continuing education activity on COPD-specific self-management support, respiratory educators with significant experience of care provided self-management support that included provision of information, inhalation technique training, and smoking cessation advice. This resulted in enhanced patient quality of life, health-directed behaviors, and skill and technique acquisition. To decrease health resource utilization, the training could employ active learning methods. More time and resources could also be devoted to implementing regular follow-up visits. CLINICAL TRIALS REGISTRATION NO: NCT02870998.

Marketing health educators to employers: survey findings, interpretations, and considerations for the profession.

In July 2007, a market research report was produced by Hezel Associates on behalf of five sponsoring health education profession member organizations and the National Commission for Health Education Credentialing. The purpose of the survey was to learn about current or potential employers' knowledge, attitudes, and behaviors toward health educators and the health education profession and their future hiring practices. This article presents the background leading up to the production of this report, the major findings of the survey of employers, recommendations from the market research group regarding core messages, and implications for the profession having discovered for the first time information about employers' understanding of professionally prepared health educators. The article discusses the umbrella and key messages that may be incorporated into a marketing plan and other recommendations by the firm that should assist health educators in marketing the profession. Furthermore, this article presents reactions by leaders in this field to these messages and recommendations and concludes with next steps in this project and a call for the overall need to market the profession of health education.

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.

Networking for career-long success: a powerful strategy for health education professionals.

Networking is a proven strategy to enhance professional recognition and skills while promoting career development. Through a variety of techniques and for a multitude of reasons, health educators can enrich their professional endeavors by interacting and engaging in formal and informal networking with others. Through networking, health education professionals can offer each other assistance and support while establishing long-lasting mutually beneficial relationships. This article provides an overview of the basics of networking, reasons that networking is important, persons who can benefit from networking, and strategies on how to network and how to develop, maintain, and nurture a network.