Competency Assessment
for Population-focused
Public Health Practice
Susan J. Zahner, DrPH, RN
Jeffrey B. Henriques, PhD
Paul M. Schwartz, MS, RN
Public Health Systems Research
Washington, 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 populationfocused 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?”
•9 domains
•65 items
Response:
1 = I need to be
taught about this
2 = I do or can do this
with help
3 = I do or can do this
4 = I do this with ease
5 = I do this and teach
it to others
Issel, Baldwin, Lyons, & Madamala, 2006
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
•
•
•
Managers
40.0
45.0
50.0
55.0 Full-time staff
Years 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)
Years in public health
Managers
Full-time staff
Part-time staff
0.0
10.0
20.0
Years
30.0
Highest degree earned
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Graduate degree
Baccalaureate
degree
Part-time
staf f
Full-time
staf f
Managers
Scale reliability
6
Research
9
Evaluate
12
Workforce
Link
4
Enforce
4
6
Policy
13
Partner
4
Inform
13
Monitor
0.8
0.85
0.9
Cronbach's Alpha
0.95
1
Mean responses by domain
Linking
3.59 (0.78)
Informing
2.83 (0.83)
Mobilizing
2.78 (0.73)
Ensuring
2.78 (0.72)
Enforcing
2.70 (0.89)
Researching
2.47 (0.72)
Monitoring
2.44 (0.76)
Planning
2.31 (0.78)
Evaluating
2.24 (0.77)
n= 296-299
1
2
3
4
5
Mean responses by domain and type of
respondent
^
Linking
Informing
*^
Mobilizing
Ensuring
*
Enforcing
*^
Researching
*^
Monitoring
*^
Part-time staff
Full-time staff
Managers
*
Planning
*^
Evaluating
1
2
3
4
5
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:
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•
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Well educated
Experienced
Aging
Discussion
Competency low in most domains
 Higher perceived competency in
traditional areas of practice
 Higher perceived competency in
managers compared to staff
 Higher competency in full-time
compared to part-time staff

Discussion
Competency assessment instrument:
Reliable
 Length
 Compare with other competency
assessment tools
 Use 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, RN
Associate Professor
UW-Madison
H6/246 CSC
600 Highland Avenue
Madison, WI 53792-2455
608-263-5282
sjzahner@wisc.edu