Levers of Change: How to Help Build the Public Health Workforce of the Future.

CONTEXT: Public health leaders are working to rebuild the US public health workforce. Master of Public Health (MPH) programs have a stake in this, given their role in educating and training public health practitioners. Over the last 10 years, MPH programs have implemented changes to program structure, content, and approach, but workforce gaps persist. OBJECTIVE: This study sought to explore the factors that inform and influence MPH program design and changes they make in order to elucidate how MPH programs may be further engaged to help address current and future public health workforce needs. DESIGN: Sequential mixed-methods study. SETTING: US MPH programs accredited by the Council on Education for Public Health (CEPH), and applicants approved to seek accreditation. PARTICIPANTS: In total, 115 representatives representing at least 43% of the 215 accredited/applicant MPH programs in the United States. MAIN OUTCOME MEASURES: Factors that inform and influence programmatic and curricular changes within MPH programs. RESULTS: The shifts that MPH programs have made to program focus and the approaches used to support student competence development are influenced by individual, programmatic, institutional, and national factors, including faculty and staff background, access to resources, program team/faculty culture, access to resources, program placement, university priorities, and national policies. Most influential in catalyzing changes made by MPH programs between 2015 and 2020 were CEPH MPH accreditation standards, feedback from interested parties, learning best practices, university initiatives, and access to resources including funding and faculty. Identified factors served as facilitators and/or as barriers, depending on the context. CONCLUSIONS: There are multiple levers at different levels that may be utilized by national public health leaders, university administrators, and program constituents to effect change within MPH programs, helping them to be even better positioned to help address public health workforce needs of today and tomorrow.

Master of Public Health Education in the United States Today: Building Leaders of the Future.

OBJECTIVES: For decades, there have been calls to action to change the status quo of public health education in the United States to respond to workforce needs and help reinforce capacity. During the last 10 years, schools and programs of public health have planned and implemented programmatic and curricular changes. This study explored the focus of master of public health (MPH) education in the United States today. METHODS: We used a 3-phase mixed-methods study to compile data to describe the current state and focus of MPH education in the United States via survey data collection (November-December 2019), semistructured interviews (January-February 2020), and document reviews. RESULTS: Survey responses represented at least 43% (93/215) of eligible MPH programs in the United States. Most respondents (86%, 99/115) reported that the primary focus of MPH education in the United States is to prepare graduates for public health practice and employment linked to public health, and 54% (59/109) reported that their MPH programs adopted this focus in the last 5 years. MPH programs invested in student learning, competence development, and supporting workforce readiness, including a focus on leadership abilities. Programs noted that they seek to develop strategic thinkers and engaged leaders with abilities to understand and address emergent public health needs. CONCLUSIONS: Public health education in the United States is in a period of change. MPH programs reported responding to workforce needs by closing gaps in workforce capacity and developing compassionate and professional leaders who can understand needs, collaborating with communities, and facilitating action that will ameliorate health disparities and promote social injustice by practicing public health in new ways.

A New Baseline: Master of Public Health Education Shifting to Meet Public Health Needs.

CONTEXT: Schools and programs of public health have been preparing graduates to join the workforce for a century, but significant gaps in numbers and abilities exit. Many have called for a change to the status quo, to transform public health education to create a competent workforce able to address current and emergent needs. OBJECTIVE: This study explored if Master of Public Health (MPH) programs have shifted their program design, curriculum, and/or instructional methods (instructional design), and if so, how and why. DESIGN: A sequential mixed-methods study. SETTING: MPH programs accredited by the Council on Education for Public Health, and approved applicants. PARTICIPANTS: Some 43% of accredited MPH programs in the United States (n = 115) responded to the online survey (open November 21, 2019-December 20, 2019), providing a representative sample. Stratified purposeful sampling was used to select 8 MPH programs for follow-up semistructured interviews. Categorical and qualitative data were analyzed for trends, association, and themes. MAIN OUTCOME MEASURES: Degree of, types of, and reasons for shifts in MPH program instructional design considered and implemented. RESULTS: MPH programs in the United States have shifted their approaches and curriculum to meet identified and emergent workforce needs. In the last 5 years, 81% made changes to program design (focal competencies, admissions, graduation criteria), 88% to curriculum (added or removed courses, changed course content), and 65% to pedagogical methods (where and how learning is supported). CONCLUSIONS: Despite concerns about stagnation, MPH programs have shifted to competency-based education aligned with workforce needs, have adapted approaches to support diversity of future workers, and are focused on bolstering workforce readiness. These changes were made to enhance focus on knowledge acquisition, skills building, and professionalism, factors recognized as critical for success, and facilitate more engaged pedagogical strategies, working with communities for impact.

Assessing Local Public Health Agency Alignment With Public Health 3.0: A Content Analysis of Illinois Community Health Improvement Plans.

CONTEXT: Public Health 3.0 described the need for public health agencies and the public health workforce to transform and obtain new skills and approaches to address the social determinants of health (SDOH) through cross-sectoral partnerships and collective action. OBJECTIVE: To assess the current state of local health departments' Public Health 3.0 alignment through interventions and initiatives documented in community health improvement plans (CHIPs). METHOD: We conducted a content analysis of Illinois CHIPs from July to November 2020. A coding framework aligned with Public Health 3.0 concepts was developed on the basis of constructs from the literature, faculty expertise, and preliminary reviews of the CHIPs. Two researchers deductively coded for health priorities and interventions in Microsoft Excel 2016 and calculated the number of CHIPs in which each code appeared. RESULTS: Ninety CHIPs representing 98 counties across the state were analyzed; 2 CHIPs were excluded because of a lack of strategies. Our content analysis found that 13% (n = 12) of CHIPs had explicit priorities related to SDOH and 12% (n = 11) included interventions that addressed socioeconomic factors. Ten percent (n = 9) of CHIPs proposed multilevel multicomponent interventions. Eighty-nine percent (n = 80) of CHIPs included community-level interventions, and 53% (n = 48) of CHIPs included policy, systems, and environmental strategies focused on specific health content. The majority of CHIPs (96%; n = 86) had at least 1 partnership strategy. Thirty-two percent (n = 29) of CHIPs mentioned the use of an evidence-based strategy. CONCLUSIONS: Our content analysis found opportunities to improve Illinois public health agencies' Public Health 3.0 capacities and capability. Findings are limited to this data source and definitions of the Public Health 3.0 attributes, leaving room for practice and research opportunities to develop operational definitions of Public Health 3.0; capacity building to improve the public health workforce readiness; and research and evaluation to measure improvements.

Results From a National Mixed-Methods Study Exploring Community Health Improvement Implementation: An Opportunity to Strengthen Public Health Systems Through Collective Action.

CONTEXT: There are multiple calls for public health agency role and workforce transformation to increase capacity to orchestrate cross-sectoral partnerships that set and implement strategies addressing the structural and social determinants of health. Mobilizing for Action through Planning and Partnerships (MAPP) may be one tool for collective action to improve population health and equity. However, little is known about the Action Cycle in MAPP and implementation of resulting community health improvement plans. OBJECTIVE: To explore the characteristics of MAPP users who completed the MAPP Action Cycle and factors that facilitated or inhibited implementation activities during this phase. METHODS: We used a sequential participatory mixed-methods design involving 2 phases of data collection. The first data collection phase included a Web-based survey using Qualtrics. The second data collection phase included qualitative key-informant interviews and focus groups. A national public health and health care advisory group informed the evaluation throughout the entire process to ground the process in practice and experience. RESULTS: This study showed that some MAPP participants do not conduct implementation activities as defined by the MAPP Action Cycle and of those who do, implementation activity varies by participant experiences conducting MAPP and accreditation status. The MAPP users who completed 3 or more rounds of MAPP were more likely to align and integrate MAPP within their agencies as well as organize a collaborative implementation process with partners. More resources and skills in planning that facilitate long-range partnerships were noted as key to implementation. CONCLUSIONS: Opportunity remains to improve implementation in MAPP. National leaders should explore and build capacity and infrastructure within public health agencies and with their partners to create a system of readiness and an infrastructure that support implementation over time.

Inclusion Wheel: Tool for Building Capacity and Public Health Leaders to Serve People With Disabilities.

Public health leaders need to influence change to serve underserved populations, such as people who have a disability. Action research was conducted with a community of practice (CoP) from Ohio to examine readiness, capacity building, and capacity factors needed for public health partners to more fully include people who have a disability (PWD) in state smoking cessation efforts. Five conditions fostered readiness, capacity building, and capacity among public health partners to include PWD: (1) successful timing of effort, (2) facilitation of discussions, (3) systematic reflection, (4) sufficient support, and (5) personal commitment of participants. Nine factors of readiness, capacity building, and capacity influenced inclusion of PWD: (1) positive perception and quality interactions with partners, (2) contact with organizations, (3) recognition of need to coordinate, (4) engagement in a network, (5) practical collaboration experience, (6) continuing education, (7), critical reflection time, (8) dedicated staff, and (9) knowledge of priority population. Readiness, capacity, and capacity building were interconnected and supported inclusion of PWD in public health efforts. Ohio public health partners used these factors and conditions to achieve the first mandatory disability awareness training for all National Jewish Health Quitline counselors. Future efforts addressing other specific demographic groups that experience health disparities can use these findings.

Perceived Benefits of Collaboration Between Local Health Departments and Schools and Programs of Public Health: A Mixed-Methods Study.

OBJECTIVES: Collaboration between local health departments (LHDs) and schools and programs of public health (SPPH) may be a way to improve practice, education, and research. However, little is known about why LHDs and SPPH collaborate. This mixed-methods study addressed this issue by exploring what LHDs and SPPH perceive to be beneficial about their collaboration. METHODS: A mixed-methods study using quantitative and qualitative data was conducted. A survey of 2000 LHDs that completed the 2013 National Profile of LHDs measured how important and effective LHDs perceived 30 indicators of the 10 essential public health services to be for collaboration with SPPH. Focus groups were held with LHD officials and the faculty from SPPH to further explore their perceptions of the mutual benefits of their collaboration. RESULTS: This study showed that LHD officials and the faculty from SPPH valued their collaborative work because it can improve education and training, support public health accreditation, enhance LHD credibility, enhance LHD technological capabilities, and improve research and evidence-based practice. Benefits increased with an increase in the degree of collaboration. This also showed that LHD officials would like to collaborate more closely with SPPH. CONCLUSION: Collaboration between LHDs and SPPH is mutually beneficial, and close collaboration can help transform public health practice, education, and research. In light of this, more attention should be paid to developing goals and objectives for a collaborative agenda. Attention should be paid not only to the immediate needs of the organizations and individuals involved but also to their long-term goals and underlying desires. Funding opportunities to support the development of partnerships between LHDs and SPPH are needed to provide tangible tasks and opportunities for taking a more long-term and strategic view for collaborative relationships.