Tracking Public Health Workforce Retention: Observations From CDC's Public Health Associate Program.

Objectives. To describe the career trajectories of 1 cohort of US Public Health Associate Program (PHAP) alumni over 3 years since completing PHAP.Methods. We distributed a Web-based survey at 3 time points between 2014 and 2017 (response rate = 76%). We calculated descriptive statistics in SPSS.Results. At all time points, most alumni were employed. Of those, the percentage employed in public health was 100% at program completion, 86% at year 1, and 68% at year 3.Conclusions. Most alumni were employed in public health jobs at each time point. At the 3-year mark, approximately a third of the alumni had left public health employment, which is in line with documented rates of turnover within the broader public health workforce.Public Health Implications. Service learning programs like PHAP are effective at recruiting early career professionals into public health. The extent to which PHAP is effective at retaining workers in public health after the program appears most promising immediately following the program or in the short term after the program concludes. The extent to which workers are retained in the longer term requires further study.

Applying Instructional Design Strategies and Behavior Theory to Household Disaster Preparedness Training.

CONTEXT: Interventions and media campaigns promoting household disaster preparedness have produced mixed results in affecting behaviors. In large part, this is due to the limited application of instructional design strategies and behavior theory, such as the Transtheoretical Model (TTM). This study describes the development and evaluation of Ready CDC, an intervention designed to increase household disaster preparedness among the Centers for Disease Control and Prevention (CDC) workforce. OBJECTIVES: (1) Describe the instructional design strategies employed in the development of Ready CDC and (2) evaluate the intervention's impact on behavior change and factors influencing stage progression for household disaster preparedness behavior. DESIGN: Ready CDC was adapted from the Federal Emergency Management Agency's (FEMA's) Ready campaign. Offered to CDC staff September 2013-November 2015, it consisted of a preassessment of preparedness attitudes and behaviors, an in-person training, behavioral reinforcement communications, and a 3-month follow-up postassessment. RESULTS: Ready CDC employed well-accepted design strategies, including presenting stimulus material and enhancing transfer of desired behavior. Excluding those in the TTM "maintenance" stage at baseline, this study determined 44% of 208 participants progressed at least 1 stage for developing a written disaster plan. Moreover, assessment of progression by stage found among participants in the "precontemplation" (n = 16), "contemplation" (n = 15), and "preparation" (n = 125) stages at baseline for assembling an emergency kit, 25%, 27%, and 43% moved beyond the "preparation" stage, respectively. Factors influencing stage movement included knowledge, attitudes, and community resiliency but varied depending on baseline stage of change. CONCLUSIONS: Employing instructional strategies and behavioral theories in preparedness interventions optimizes the potential for individuals to adopt preparedness behaviors. Study findings suggest that stage movement toward household preparedness was not spurious but rather associated with the intervention. Therefore, Ready CDC was successful in moving staff along the continuous process of adopting household disaster preparedness behaviors, thus providing a model for future interventions. The TTM suggests factors such as knowledge, beliefs, and self-efficacy will differ by stage and may differentially predict progression towards behavior adoption. Thus, tailoring interventions based on an individual's stage of change optimizes the potential for individuals to adopt desired behaviors.

Assessing Participants' Experiences in a Service-Learning Program: A Psychometric Evaluation.

There is currently a gap in the literature regarding the creation of psychometrically sound measurement tools assessing service-learning programs in health-related fields. Without comprehension of a survey's psychometric properties, evaluators cannot ensure that survey instruments are reliable or valid. This study describes the psychometric evaluation of the Public Health Associate Program (PHAP) Service-Learning Scale (PSLS). PSLS assesses participant experience in PHAP, a Centers for Disease Control and Prevention program. This paper explains survey development, scale validity and reliability, and the internal factor structure of the PSLS. The final scale consisted of 22 items with a high internal consistency (Cronbach's α=.90). Exploratory Factor Analysis (EFA) was used to determine the scale's factor structure; five factors comprising of all 22 items were retained. The factors, or subscales, were Learning Outcomes, Mentoring, Experiential Assignment, Self-Efficacy in Program Competency Domains, and Program Satisfaction. All were also found to have adequate internal consistency (Cronbach's α >.70). Service-learning is vital in developing the next generation of the workforce. These study findings suggest the PSLS fills a critical gap in the literature by providing a valid and reliable instrument to evaluate experiences and satisfaction in service-learning programs and other fellowships.

Early Evaluation Findings From a Federally Funded Training Program: The Public Health Associate Program.

OBJECTIVE: The Centers for Disease Control and Prevention (CDC) created the Public Health Associate Program (PHAP) to establish a continuous source of public health professionals who can deliver frontline services at the federal, state, tribal, local, and territorial levels. The article describes preliminary evaluation findings for PHAP. DESIGN: The evaluation's primary purposes are to assess the quality and effectiveness of PHAP, determine its value and impact, and provide information to continuously improve the program. Because the evaluation is both formative and summative and focuses on aggregate outputs and outcomes of PHAP, the methodology is complex and builds over time as different cohorts cycle into and out of the program. Results presented are outcomes of various Web-based surveys and reporting systems. PARTICIPANTS: Four PHAP cohorts, consisting of 579 individuals, participated in 1 or more of the evaluation activities described in this article. RESULTS: The majority of participants report satisfaction with their PHAP experiences, and 74% of recent graduates indicate they are continuing their careers or education in public health immediately after program completion. Seventy-eight percent of recent PHAP graduates who accept a job in public health are employed by the federal government. One year post-PHAP, 74% of alumni report that PHAP has been influential in their careers. CONCLUSION: CDC's investment in PHAP has increased the capacity and capabilities of the public health workforce. Results presented are early indicators of program quality, effectiveness, and impact. Today's public health workers are asked to do more with less, in the face of a dynamic array of complex public health challenges. PHAP offers public health agencies assistance in tackling these losses and challenges.

Service Learning in Public Health: Exploring the Benefit to Host Agencies in CDC's Public Health Associate Program.

The "learn by doing" approach to training is common in the public health field and is a core component of service-learning programs. Trainee satisfaction, learning, and application of learning have been studied. What is less understood is the perspective of the agencies that host trainees. This study aimed to identify whether and how the Centers for Disease Control and Prevention's Public Health Associate Program (PHAP) adds value to the agencies that host trainees during 2-year field assignments. An exploratory, qualitative study design consisting of 9 semistructured telephone interviews with PHAP host agency supervisors was used. Results suggested that PHAP increased host agencies' capacity by assigning capable trainees to host agencies. Trainees made quality contributions that led to agency- and/or community-wide improvements and positively affected the agencies' culture. Further evaluation of the host perspective is necessary; as coupled with the trainee's perspective, it will provide a more holistic understanding of program value.

A whole community approach to emergency management: Strategies and best practices of seven community programs.

OBJECTIVE: In 2011, the Federal Emergency Management Agency (FEMA) published the Whole Community Approach to Emergency Management: Principles, Themes, and Pathways for Action, outlining the need for increased individual preparedness and more widespread community engagement to enhance the overall resiliency and security of communities. However, there is limited evidence of how to build a whole community approach to emergency management that provides real-world, practical examples and applications. This article reports on the strategies and best practices gleaned from seven community programs fostering a whole community approach to emergency management. DESIGN: The project team engaged in informal conversations with community stakeholders to learn about their programs during routine monitoring activities, site visits, and during an in-person, facilitated workshop. A total of 88 community members associated with the programs examples contributed. Qualitative analysis was conducted. RESULTS: The findings highlighted best practices gleaned from the seven programs that other communities can leverage to build and maintain their own whole community programs. The findings from the programs also support and validate the three principles and six strategic themes outlined by FEMA. CONCLUSIONS: The findings, like the whole community document, highlight the importance of understanding the community, building relationships, empowering action, and fostering social capital to build a whole community approach.