Developing State Leadership in Maternal and Child Health: Process Evaluation Findings from a Work-Based Learning Model for Leadership Development.

OBJECTIVES: Since 2013 the MCH Bureau has supported the National MCH Workforce Development Center to strengthen the Title V MCH workforce. This article describes the Center's Cohort Program and lessons learned about work-based learning, instruction, and coaching. DESCRIPTION: The Cohort Program is a leadership development program that enrolls state-level teams for skill development and work-based learning to address a self-identified challenge in their state. Teams attend a Learning Institute that teaches concepts, skills, and practical tools in systems integration; change management and adaptive leadership; and evidence-based decision-making and implementation. Teams then work back home on their challenges, aided by coaching. The Program's goals are for teams to expand and use their skills to address their challenge, and that teams would strengthen programs, organizations, and policies, use their skills to address other challenges, and ultimately improve MCH outcomes. METHODS: This process evaluation is based on evaluation forms completed by attendees at the three-day Learning Institute; six-month follow-up interviews with team leaders; and a modified focus group with staff. RESULTS: Participants and staff believe the Cohort Program effectively merges a practical skill-based curriculum, work-based learning in teams, and coaching. The Learning Institute provides a foundation of skills and tools, strengthens the team's relationship with their coach, and builds the team. The work-based learning period provides structure, accountability, and a "practice space" for teams to apply the Cohort Program's skills and tools to address their challenge. In this period, teams deepen collaborations and often add partners. The coach provides accessible and tailored guidance in teamwork and skill application. These dimensions helped teams in develop skills and address state-level MCH challenges. CONCLUSIONS FOR PRACTICE: Continuing professional development programs can help leaders learn to address complex state-level MCH challenges through integrated classroom-based skills development, work-based learning on state challenges, and tailored coaching.

Eliciting vulnerable patients' preferences regarding colorectal cancer screening: a systematic review.

BACKGROUND: Patient preferences are important to consider in the decision-making process for colorectal cancer (CRC) screening. Vulnerable populations, such as racial/ethnic minorities and low-income, veteran, and rural populations, exhibit lower screening uptake. This systematic review summarizes the existing literature on vulnerable patient populations' preferences regarding CRC screening. METHODS: We searched the CINAHL, PsycINFO, PubMed, Scopus, and Web of Science databases for articles published between January 1, 1996 and December 31, 2017. We screened studies for eligibility and systematically abstracted and compared study designs and outcomes. RESULTS: A total of 43 articles met the inclusion criteria, out of 2,106 articles found in our search. These 43 articles were organized by the primary sub-population(s) whose preferences were reported: 27 report on preferences among racial/ethnic minorities, eight among low-income groups, six among veterans, and two among rural populations. The majority of studies (n=34) focused on preferences related to test modality. No single test modality was overwhelmingly supported by all sub-populations, although veterans seemed to prefer colonoscopy. Test attributes such as accuracy, sensitivity, cost, and convenience were also noted as important features. Furthermore, a preference for shared decision-making between vulnerable patients and providers was found. CONCLUSION: The heterogeneity in study design, populations, and outcomes of the selected studies revealed a wide spectrum of CRC screening preferences within vulnerable populations. More decision aids and discrete choice experiments that focus on vulnerable populations are needed to gain a more nuanced understanding of how vulnerable populations weigh particular features of screening methods. Improved CRC screening rates may be achieved through the alignment of vulnerable populations' preferences with screening program design and provider practices. Collaborative decision-making between providers and vulnerable patients in preventive care decisions may also be important.

An evaluation of the National Public Health Leadership Institute--1991-2006: part I. Developing individual leaders.

CONTEXT: Public health leadership development programs are widely employed to strengthen leaders and leadership networks and ultimately agencies and systems. The year-long National Public Health Leadership Institute's (PHLI) goals are to develop the capacity of individual leaders and networks of leaders so that both can lead improvement in public health systems, infrastructure, and population health. OBJECTIVE: To evaluate the impact of PHLI on individual graduates using data collected from the first 15 cohorts. PARTICIPANTS: Between 1992 and 2006, PHLI graduated 806 senior leaders from governmental agencies, academia, health care, associations, nonprofit organizations, foundations, and other organizations. Of 646 graduates located, 393 (61%) responded to a survey, for an overall response rate of 49% (393/806). INTERVENTION: PHLI has included retreats; readings, conference calls, and webinars; assessments, feedback, and coaching; and action learning projects, in which graduates apply concepts to a work challenge aided by peers and a coach. METHODS: A survey of all graduates and interviews of 34 graduates and one other key informant. RESULTS: PHLI improved graduates' understanding, skills, and self-awareness, strengthened many graduates' connections to a network of leaders, and significantly increased graduates' voluntary leadership activities at local, state, and national levels (P < .001). Deeper and wider network connections shaped graduates' sense of "belonging" to the national cadre of public health leaders, provided access to supportive peers and ideas, and bolstered confidence and interest in taking on leadership work. Nearly all graduates remained in public health. Some partially attributed to PHLI their promotions into more senior positions. CONCLUSION: Leadership development programs can strengthen and sustain their impact by cultivating sustained "communities of practice" that provide ongoing support for skill development and innovative practice. Sponsors can fruitfully view leadership development as a long-term investment in individuals and networks within organizations or fields of practice.

Linking learning methods to outcomes in public health leadership development.

PURPOSE: The purpose of this research is to present evaluation findings from the National Public Health Leadership Institute (PHLI) regarding how the curriculum's learning methods work singly and together to produce outcomes for learners and their organizations. DESIGN/METHODOLOGY/APPROACH: Six months after graduation from PHLI, four recent cohorts of PHLI graduates were asked to report overall reactions to PHLI by using an online survey. The survey consisted of quantitative questions about key leadership behaviors taught in the program and the usefulness of PHLI's five learning methods as well as qualitative questions about changes in understanding, skill, practices, and outcomes. FINDINGS: The evaluation survey yielded a 66 percent response rate (n=133). PHLI's learning methods are interrelated and lead to such outcomes as changed leadership understanding, knowledge and skill development, increased confidence, increased self-awareness, leadership practice changes, and organizational results. The learning project was strongly associated with development of collaborations, whereas assessment tools and coaching were most often associated with increased self-awareness. RESEARCH LIMITATIONS/IMPLICATIONS: These preliminary findings support the idea that particular learning methods are related to specific outcomes. However, graduates often integrate information and skills from multiple methods to achieve outcomes. Future research should investigate whether the associations identified in this evaluation are present in other leadership development programs. ORIGINALITY/VALUE: This is the first published evaluation that has attempted to link specific learning methods with outcomes for participants of a public health leadership development program.

The Management Academy for Public Health: program design and critical success factors.

The Management Academy for Public Health is a team-based training program jointly offered by the School of Public Health and the Kenan-Flagler Business School at the University of North Carolina at Chapel Hill. This 9-month program teaches public health managers how to better manage people, information, and finances. Participants learn how to work in teams with community partners, and how to think and behave as social entrepreneurs. To practice and blend their new skills, teams develop a business plan that addresses a local public health issue. This article describes the program and explains the findings of the process evaluation, which has examined how best to structure and deploy a team-based method to create more effective, more entrepreneurial public health managers. Findings indicate that recruitment and retention are strong, program elements are relevant to learners' needs, and learners are satisfied with and value the program. Several specific benefits of the program model are identified, as well as several elements that support business plan success and skills' application on the job. On the basis of these findings, four success factors critical for developing similar programs are identified.

The UNC Management Academy for Public Health: how the UNC School of Public Health and the Kenan-Flagler Business School created a winning partnership.

The University of North Carolina Management Academy for Public Health is a unique training program that combines a business education with a public health focus, to enhance the performance of individual public health managers and improve organizational strength throughout governmental public health. This article considers the implications of decisions made in creating this program, which, after initial funding through the Centers for Disease Control and Prevention Foundation, is now self-sustaining through participant fees. It details the principles behind the program's design, curriculum, evaluation, and sustainability strategies; presents results of the ongoing partnership; and draws conclusions about the program's future ability to meet a national need for public health management training.

Evaluating the impact of the Management Academy for Public Health: developing entrepreneurial managers and organizations.

The Management Academy for Public Health is a management development program with the goals of helping public health managers learn to manage people, data, and finance, to think and plan like entrepreneurs, and to strengthen public health organizations. Managers enroll as teams and develop business plans in the Academy's extensive project-based learning component. Extensive internal and external evaluation shows that the program improves managers' knowledge, skills, and confidence in key curriculum areas; that participants apply many of the skills in their jobs; that many of the business plans receive funding, resulting in new public health programs; that the training experience helped agencies respond and plan after September 11, 2001; and that many participants report beginning to think more like entrepreneurs through activities like teaming, partnering, innovating, negotiating, finding funds, and generating revenue. The program demonstrates that robust training including extensive work-based project work with coaching can help public health managers gain many skills needed for the drive to "reinvent" government.

Online analytic and technical training.

The authors describe the effect of online analytic and technical skills training tools on professional development and practice. Three questions were addressed: (1) Will maternal and child health and other public health professionals register for and engage in online training opportunities? (2) Was this mode of instruction perceived to be an effective means for learning specific skills? and (3) What was the impact of the tools on user knowledge, confidence, practice, and sharing of skills with colleagues? Evaluating open-enrollment online training posed significant challenges. Nonetheless, registration data and the responses to the online surveys affirmed that the opportunity for asynchronous, online learning was an effective means for learning specific skills.

Impact studies in continuing education for health professions: update.

INTRODUCTION: This article critiques the questions asked and methods used in research syntheses in continuing education (CE) in the health professions, summarizes the findings of the syntheses, and makes recommendations for future CE research and practice. METHODS: We identified 15 research syntheses published after 1993 in which primary CE studies were reviewed and the performance (behavior) of health professionals and/or patient health outcomes were examined. RESULTS: The syntheses were categorized by the research questions they asked using a wave metaphor. Wave One (n = 3) syntheses sought to establish a general descriptive causal connection between CE and impact variables, asking, "Is CE effective, and for what outcomes?" Wave Two syntheses (n = 12) sought to explain the relationship between CE and impacts by identifying causal moderators, asking, "What kinds of CE are effective?" DISCUSSION: Wave One findings confirm previous research that CE can improve knowledge, skills, attitudes, behavior, and patient health outcomes. Wave Two syntheses show that CE, which is ongoing, interactive, contextually relevant, and based on needs assessment, can improve knowledge, skills, attitudes, behavior, and health care outcomes. The most important implication of the present review is that there are differential impacts of CE programs, and the reasons for those impacts cannot be fully understood unless the context of the program is considered.

An interdisciplinary MPH via distance learning: meeting the educational needs of practitioners.

This article describes a distance learning master of public health program that prepares students to lead programs and organizations. Evaluation showed that the curriculum, format, and teaching methods were accessible, affordable, acceptable, and appropriate for the working professional, and equivalent to residential master's programs aimed at experienced professionals. Students interacted with professors and other learners using the World Wide Web, weekly videoconferences, and face-to-face meetings. Students, whose main motivations for enrolling included improving job performance in leadership and career advancement, reported strengthening of knowledge, perspective, skill, technical facility, confidence, and job performance. Learner satisfaction was high, with 100% agreeing they would recommend the program to others.