Competency Assessment for Population-focused Public Health Practice

Susan J. Zahner, DrPH, RNJeffrey B. Henriques, PhDPaul M. Schwartz, MS, RN

Public Health Systems ResearchWashington, DC

June 7, 2008

Funded by US DHHS/PHS/HRSA, Division of Nursing # D11HP07731-01

Background

Statutes emphasize core functions and essential services

Changes in practice require new knowledge, skills and attitudes

Core competencies for public health professionals published/adapted

No standard competency assessment method

No prior competency assessment of PHN in Wisconsin

Linking Education and Practice for Excellence in Public Health Nursing

Statewide academic-practice partnership

Improve competency for population-focused PHN practice• Improved education for students• Improved orientation • Continuing education

Baseline assessment

Funded by US DHHS/PHS/HRSA, Division of Nursing # D11HP07731-01

Study methods

• UW-Madison IRB approval• Self-reported competency assessment

instrument (Issel, Baldwin, Lyons, & Madamala, 2006)

• ACHNE/Essential Services (2000)• Reliability/validity• Length

• Web-delivered (Websurvey@UW)• Cross-sectional baseline survey

Competency assessment instrument

Stem: “How competent do you feel with your knowledge or skills in each of the following areas?”

Response:1 = I need to be taught

about this2 = I do or can do this

with help3 = I do or can do this4 = I do this with ease5 = I do this and teach

it to others

Issel, Baldwin, Lyons, & Madamala, 2006

•9 domains•65 items

Competency assessment instrument domains (item #)

• Monitoring community health status (13 items)• Informing, educating, and empowering

populations at risk (4 items)• Mobilizing community partnerships (13 items)• Policy and planning skills (6 items)• Enforcement of laws and regulations (4 items)• Linking people to services (4 items)• Ensuring a competent workforce (12 items)• Evaluating health services (9 items)• Researching innovative solutions (6 items)

Issel, Baldwin, Lyons, & Madamala, 2006

Survey administration

• Wisconsin Health Alert Network • PHN Group email list• Removed state-level PHN addresses• N=471

• Email invitation to participate• Reminder emails at 2 and 3 weeks• April-September 2007

Participant demographics

Mean age

40.0 45.0 50.0 55.0Years

ManagersFull-time staffPart-time staff

0.0 10.0 20.0 30.0 Years

Years in public health

Managers

Full-time staff

Part-time staff

• Response rate = 63.5% (299/471)

• Female (97.8%)• White, non-Hispanic (97%)• Part-time staff (n=76)• Full-time staff (n=153)• Managers (n=42)

0%10%20%30%40%50%60%70%80%90%

100%

Part-time staff

Full-time staff

Managers

Highest degree earned

Graduate degree

Baccalaureate degree

Scale reliability

0.8 0.85 0.9 0.95 1

Monitor

Inform

Partner

Policy

Enforce

Link

Workforce

Evaluate

Research

Cronbach's Alpha

6

9

12

4

4

6

13

4

13

Mean responses by domain

1 2 3 4 5

Evaluating

Planning

Monitoring

Researching

Enforcing

Ensuring

Mobilizing

Informing

Linking

n= 296-299

2.78 (0.72)

2.70 (0.89)

2.47 (0.72)

2.44 (0.76)

2.31 (0.78)

2.24 (0.77)

2.78 (0.73)

2.83 (0.83)

3.59 (0.78)

Mean responses by domain and type of respondent

1 2 3 4 5

Evaluating

Planning

Monitoring

Researching

Enforcing

Ensuring

Mobilizing

Informing

Linking

Part-time staffFull-time staffManagers

^

Significance at alpha <.05 via one-tailed Tukey B post-hoc comparison:* = Managers/full-time ^ = Full-time/part-time

* ^

*

* ^

* ^

* ^

*

* ^

Limitations-sample

Group email list incomplete and voluntary

Under-representation of PHN by region of state

Limited generalizability

Limitations-instrument

Self-assessed perceptions versus observed competency

Response category “5” may not reflect the same concept as “1 – 4” responses

“doing with help”

Discussion

WI PHN workforce is:

• Well educated • Experienced• Aging

Discussion

Competency low in most domainsHigher perceived competency in

traditional areas of practiceHigher perceived competency in

managers compared to staff Higher competency in full-time

compared to part-time staff

Discussion

Competency assessment instrument: ReliableLengthCompare with other competency

assessment toolsUse by other public health

professionals

Conclusion

Change in practice for staff PHN toward more systems-level activity based on essential services will require additional training and support to achieve perception of competency

Next steps

• LEAP Project activities• Academia/practice regional learning

collaboratives• Orientation program• Continuing education

• Follow-up survey• Comparison with Illinois

References

Issel, L. M., Baldwin, K. A., Lyons, R. L., & Madamala, K. (2006). Self-reported competency of public health nurses and faculty in Illinois. Public Health Nursing, 23(2), 168-177.

Public Health Functions Steering Committee. (1994). The public health workforce: An agenda for the 21st century. Full report of the Public Health Functions Project. Washington, DC: U.S. Department of Health and Human Services, Public Health Service.

Quad Council of Public Health Nursing Organizations. (2004). Public health nursing competencies. Public Health Nursing., 21(5), 443-452.

Wisconsin Department of Health & Family Services. (2005). Public Health Profiles for Wisconsin. Retrieved October 22, 2007, from http://dhfs.wisconsin.gov/localdata/pubhlthprofiles.htm

Questions?

Contact: Susan Zahner, DrPH, RNAssociate ProfessorUW-Madison H6/246 CSC600 Highland AvenueMadison, WI 53792-2455608-263-5282sjzahner@wisc.edu