Identifying core competencies for practicing public health professionals: results from a Delphi exercise in Uttar Pradesh, India

The Core Competencies for Public Health in Canada: Release 2.0 are the knowledge, skills, attitudes and behaviors expected of all individuals working in any public health role, at any level, in Canada. The original competencies, released in 2008, recently underwent modernization, resulting in an updated set of 65 competencies across 10 categories, with applicability to public health in diverse countries and contexts. To support the development of these competencies across the public health workforce, ongoing professional development and workforce training will be needed. To support the public health community in achieving the modernized core competencies, the National Collaborating Centre for Methods and Tools (NCCMT) developed a curated list of learning resources mapped to the competency statements. An environmental scan was conducted to identify online courses, learning modules and workshops relevant to public health, and the Core Competencies for Public Health in Canada. These resources were then mapped to each of the competency statements. A web-based tool was developed, allowing users to quickly identify appropriate capacity-building resources related to specific competency categories or statements. This resource provides public health users with accessible opportunities for advancement toward achieving each core competency. A curated list of learning opportunities and resources to support competence achievement was developed to provide public health professionals with opportunities to build knowledge and skills toward each core competency. Rather than a comprehensive list of all available resources, resources were selected based on their accessibility, directness to the competency, and relevance to public health practice. The NCCMT's core competency self-assessment and curated resources list support public health professionals in achieving each core competency. Together, these resources support the advancements of quality and equitability of public health in Canada.Key messages• Core competency resources support achieving each core competency, to advance public health in Canada.• The Canadian public health core competencies and supporting resources are applicable to public health practice around the world.

Developing a unique set of Core Competencies should be of primary concern to any business operating in the hospitality industry. This paper presents a framework for competency development, which is based on the views of both educators and industry professionals. By integrating knowledge from a variety of contexts and countries around the world, a set of generic core competencies has been derived via a systematic classification process. Specifically, forty competency statements have been posited taking the form of questions given to both educators and industry professionals. Subsequently, the responses have been analysed and, using taxonomy, a framework of seven core competency categories has been developed. The competency categories involve aspects of Human Resource Management (HRM); Professional Image; Operational Knowledge; Leadership; Communication; Information Management; and People Relationship Management. Specific competency items include essential capabilities for the hospitality industry such as: communicating effectively with clients and customers, identifying and solving problems, making decisions under pressure or in a crisis situation, and understanding the factors that influence the profitability of the hospitality enterprise. The proposed framework is meant to serve as a basis for developing a set of core competencies suitable for creating a sustainable competitive advantage for the hospitality industry. Further, the framework would be useful to educators, professionals and graduate students as a guide for cultivating a set of key competencies for success in the hospitality sector.

BackgroundCore competences has been developed for public health professionals worldwide. However, there is no core competences framework as to how to evaluate public health professionals and undergraduate students’ ability to respond to public health emergencies.ObjectivesTo develop a framework of core competences in public health emergencies for education of medical college student who majored in public health. To assess the knowledge and skill level of undergraduate students with public health background in respond to health emergency event and get to known the training needs.MethodsThe Delphi method was applied to develop an agreed list of competences, which was followed by the construction of a competences framework in public health emergencies. A questionnaire consists of items that was derived from the list of competency statements developed by Delphi scoring to quantitatively report the knowledge and practical skill level and training needs of medical college students of public health background in public health emergencies.ResultsAn agreed set of core competences containing 43 statements was derived from the first and second Delphi scoring steps which can be grouped into four domains: intellectual competences, practical competences, behavioral competences, personnel and motivation. A total of 441 undergraduate students with public health background participated in the survey. The average performance of intellectual and practical competences is 3 in a 5-point scale, which equals 60 converted to 100 points. A better performance was observed in indicators of behavioral competences and personnel and motivation with an average score of 4 for most of the items, which equals 80 converted to 100 points. Admission year and sex are significantly related to competency performance of all domains with β value of −0.141 (p = 0.003) and − 0.237 (p < 0.001) for the overall performance.ConclusionA framework of 43 core competences was developed, which covered both technical and general competencies in public health emergencies and represent the current competence demands of public health work force to be qualified for their job roles in public health emergencies for the local government in Fujian province. The concordance rate regarding to score of importance of the core competences are all >80% in both the first and second round Delphi survey, suggesting considerable reliability of the framework.

Background:Public health professionals play a significant role in primary care services in Thailand. Although efforts are being taken to establish professional standards it has neither been outlined nor been officially announced. There is a lack of understanding of what is a suitable set of core competencies for a public health professional.Objectives:This study aimed to explore the core competencies of public health professionals at the primary care service level in Thailand.Methods:A quantitative survey using a questionnaire was conducted in 862 public health professionals in the northeast of Thailand. Exploratory factor analysis was applied to develop a tool to test the competencies of public health professionals.Results:The results revealed core competencies in the following five main proficiencies: (1) public health administration and laws; (2) disease prevention and control; (3) social and environmental determinant of health and health research; (4) health promotion and community; and (5) basic medical care, screening, and diagnosis. In addition, the five core competencies included 50 items suitable for this sample. These factors accounted for 71.90% of the variance.Conclusion:In conclusion, this study’s finding provides significant recommendations to policymakers to improve and initiate a new policy or a standard guideline for public health education and human resource for health production and management in Thailand.

ObjectiveTo develop an enriched set of core competencies for health services and policy research (HSPR) doctoral training that will help graduates maximize their impact across a range of academic and nonacademic work environments and roles.Data Sources/Study SettingData were obtained from multiple sources, including literature reviews, key informant interviews, stakeholder consultations, and Expert Working Group (EWG) meetings between January 2015 and March 2016. The study setting is Canada.Study DesignThe study used qualitative methods and an iterative development process with significant stakeholder engagement throughout.Data Collection/Extraction MethodsThe literature reviews, key informant interviews, existing data on graduate career trajectories, and EWG deliberations informed the identification of career profiles for HSPR graduates and the competencies required to succeed in these roles. Stakeholder consultations were held to vet, refine, and validate the competencies.Principal FindingsThe EWG reached consensus on six sectors and eight primary roles in which HSPR doctoral graduates can bring value to employers and the health system. Additionally, 10 core competencies were identified that should be included or further emphasized in the training of HSPR doctoral students to increase their preparedness and potential for impact in a variety of roles within and outside of traditional academic workplaces.ConclusionThe results offer an expanded view of potential career paths for HSPR doctoral graduates and provide recommendations for an expanded set of core competencies that will better equip graduates to maximize their impact on the health system.

Identifying public health competencies for Australian pharmacists: A modified Delphi study.

Proposal for Life Course Intervention Researcher Core Competencies.

Public health authorities have prioritized the identification of competencies, yet little empirical data exist to support decisions on competency selection among particular disciplines. We sought perspectives on important competencies among epidemiologists familiar with or practicing in public health settings (local to national). Using a sequential, qualitative-quantitative mixed method design, we conducted key informant interviews with 12 public health practitioners familiar with front-line epidemiologists' practice, followed by a web-based survey of members of a provincial association of public health epidemiologists (90 respondents of 155 eligible) and a consensus workshop. Competency statements were drawn from existing core competency lists and those identified by key informants, and ranked by extent of agreement in importance for entry-level practitioners. Competencies in quantitative methods and analysis, critical appraisal of scientific evidence and knowledge transfer of scientific data to other members of the public health team were all regarded as very important for public health epidemiologists. Epidemiologist competencies focused on the provision, interpretation and 'translation' of evidence to inform decision-making by other public health professionals. Considerable tension existed around some potential competency items, particularly in the areas of more advanced database and data-analytic skills. Empirical data can inform discussions of discipline-specific competencies as one input to decisions about competencies appropriate for epidemiologists in the public health workforce.

The process of updating the Core Competencies for Public Health in Canada, Release 1.0, was initiated in 2023 using a multi-method approach. This included evidence syntheses, an extensive engagement process to ensure relevance to current public health challenges and a Delphi survey. The objective of this study was to assess agreement on the updated competency statements among a diverse range of public health professionals, educators, policymakers, and community representatives across Canada. A modified Delphi survey was conducted in English and French to assess agreement with 68 draft competency statements across 10 categories. Eligible participants were members of the Canadian public health community who were 18years of age or older and able to participate in either official language. Participants rated their agreement with each statement using a 6-point Likert scale, with an a priori agreement threshold set at 70%. Agreement was defined as the number of participants who responded with 'agree' or 'strongly agree' to a statement, with a predefined threshold set at 70%. Open-ended text boxes allowed for qualitative feedback, which was analyzed thematically. High agreement was achieved across all competency categories and statements, with a mean agreement level of 86.1% and an average of 551 responses per statement. The highest agreement was found in the Communication category (mean agreement of 91.5%), while the Public Health Advocacy category had the lowest agreement (79.5%). Participants expressed strong support for the inclusion of new categories and updated statements not present in Release 1.0, particularly those emphasizing social justice, technology, and advocacy. Thematic analysis revealed widespread appreciation for the update and its enhanced focus on social justice, health equity, and Indigenous inclusion, alongside concerns about tailoring expectations based on professional roles and experience. The high agreement obtained from a diverse cross-section of stakeholders affirms the relevance of the revised categories and statements to contemporary and future public health practice. These findings supported the finalization of the Core Competencies for Public Health in Canada, Release 2.0. Ongoing efforts will focus on engaging knowledge user groups and embedding the competencies into workforce planning, development, education, and training.

Health Official Roles Attending the now virtual meetings of the Association of State and Territorial Health Officials (ASTHO) alumni society facilitates seeing old friends and meeting new members. However, attendance at the alumni society also signifies that someone is a former state or territorial health official (STHO). Often, membership in the ASTHO alumni society has occurred as a planned resignation (eg, retirement, new job offer), but recent experiences suggest a trend of health officials at the state, territorial, and local levels stepping down or being involuntarily removed.1–4 In the current political climate where science in general and public health science in particular has become politicized, the recommendations and decisions of state and local health officials are being scrutinized in the context of public opinion. Most people would agree that public opinion should not influence the interpretation of scientific evidence. However, because public opinion often influences politicians and because health officials commonly serve communities at the pleasure of an elected official, public opinion and politics can unduly influence scientific recommendations. The current COVID-19 pandemic has highlighted numerous instances where this has occurred.5–8 Public health response activities (eg, contact tracing), as well as recommendations regarding stay-at-home orders, social distancing, wearing masks, and other protective health measures, have all been influenced or scrutinized by public opinion and politics.9–12 Public health leaders are not exempt from these critiques. At the August 2020 meeting of the ASTHO alumni society, 5 new members joined the Zoom meeting of dozens of other former STHOs. While recent research shows that on average STHOs have relatively brief tenures (2.5 years) leading state public health agencies,13,14 many involved in leadership and related research have held the assumption that at least local health officials experience more stability and are thereby able to provide more consistent leadership. Alas, in the current age of a politicized COVID-19 response, it seems that no health officials are assured job security. In fact, according to data collected through personal communications and media reports, since March 2020 when the nation declared a state of emergency due to the COVID-19 pandemic, more than 55 state, territorial, and local health officials have become alumni and members of the group of former health officials. Some of this turnover is the result of planned retirements, but the decisions to step down, move on, or retire during the pandemic may be tied to the intense public scrutiny and literal death threats health officials have been receiving while accruing 70-80 plus weekly hours of nonstop public health response work.1–4 Mello et al15 detailed these attacks in their recent commentary, drawing attention to the need to protect public health leaders from violence and harassment. Similarly, this commentary intends to shine a bright light on the intense controversy and conflict public health officials experience in making policy recommendations to elected leaders and the public in the middle of the COVID-19 pandemic. Turnover During the COVID-19 Pandemic One of the first triggers that alerted the National Association of County and City Health Officials (NACCHO) that turnover was going to be problematic was when 3 board members turned over within 1 month early in the pandemic. At that point, NACCHO started tracking turnover more closely. ASTHO was doing the same. Since the start of the pandemic, 18 of the collective 59 STHOs have left office, with at least 33% of this turnover attributable to conflicts with elected officials and/or threats of physical harm/harassment from the public (e-mail with Michael Fraser, PhD, CEO of ASTHO, dated Aug. 9, 2020). Similarly, at the local level, of the 37 county/city health officials who have left office during the pandemic, 30% did so because of COVID-19 response conflicts with local politicians or public threats (e-mail with Lori Freeman, MBA, CEO of NACCHO, dated Aug. 24, 2020). This means that many public health agencies responsible for protecting the public's health are experiencing disruptions in leadership during the most challenging public health event of our lifetime. Leadership turnover is organizationally disruptive to a public health agency during routine operations, but when it occurs during a pandemic it can be especially difficult for the agency's response efforts. Given the many issues leadership turnover creates, it seems prudent that we support health officials staying in their roles as long as possible. Turnover of senior management roles within organizations, especially at the CEO level, is known to have a significantly negative impact on the organization's productivity and effectiveness, and transitions have to be well managed and communicated lest the agency performance deteriorate or stall. In a recent study, where former STHOs were asked to reflect on what would have helped them be more successful in their leadership roles, they reported needing a better understanding of the political process and how to relate to the governor's office before taking the job.16 Former STHOs also highlighted a need to better understand state government overall. The collective skill set of political astuteness appears to be critical for public health leader success, not just in retaining their jobs but also in tackling public health problems from a systems perspective and challenging policy failures and developing new policy approaches as a result.17 Findings from a qualitative study that assessed the perceptions of senior public health agency deputies (eg, those directly reporting to STHOs) suggested that being able to manage and meet gubernatorial expectations was a key characteristic of STHO success.18 However, many in health officer roles have no prior experience in politics and often come from clinical practice, academia, corporate settings, and organizations whose decision making is not determined by legislatures or chief elected officials. Making Improvements to Health Official Positions In an examination of the training and experiences of current and former STHOs, findings indicate that the majority (64.6%) are medical doctors. Approximately half of STHOs have public health degrees (48.3%), but only 21.8% have formal academic training in management or administration.19 While understanding public health issues is important, it is now increasingly clear that health officials require a skill set in operational management, strategic thinking, and change management. These are topics not traditionally covered in medical school, nor always consistent with health officials' expectations before taking the job.20 In fact, common reasons why STHOs reported they were involuntarily removed from their positions include difficulties in managing a situation or because they failed to understand or adequately manage the expectations of elected leadership. With turnover so common and the job so difficult, one has to wonder: who wants to be a health official? Fortunately, for the public's health, there are still individuals who seek the opportunity to serve their community and improve the health and well-being of the public. Given the recent turnover among health officials and experience of leading in a global pandemic, we suggest that now is the time to reach consensus on what success as a health official looks like. Having clear priorities and expectations can also facilitate the development of job descriptions that explicitly clarify what "good" means and how governors or mayors define "success" for their health official appointee.21 Perspectives of success may vary, but the skills necessary include being able to navigate conflict, managing partnerships, communicating effectively in crisis, and having political acumen. Could it be time to establish contracts, including assured term lengths and even severance arrangements for health officers, similar to those that exist for other public sector leaders such as school superintendents, university presidents, and other federal executive roles such as the surgeon general or the FBI (Federal Bureau of Investigation) director? Given the importance of this role, and the expertise needed, it seems unfair to require health officials to put their career and safety at risk every time they have to make tough decisions as part of their job without some protections for doing so. Leading the Way Out of the Pandemic The pandemic has caused a uniquely stressful and sobering time for our nation. In addition to division and unrest stemming from the pandemic, we have unprecedented attention on racism and an urgent need to recognize structural racism as a public health issue.22–26 We are also planning for unprecedented vaccine administration challenges, concurrently during continuing efforts to mitigate COVID-19, and addressing other public health challenges such as drug addiction and suicide that have amplified during the pandemic. State and local health department staff are working nonstop assignments without a light at the end of the tunnel. As many on the front lines of health care and public health response can attest, it is hard to sprint a marathon. To combat the fatigue and to ensure that the essential public health services can be seamlessly provided, agencies should consider crisis management strategies that manage COVID-19 operations separately but in consort with day-to-day agency activities by designating and authorizing a senior deputy to handle routine operations and give top leaders some breathing space. Such alternative "B-team" strategies, although not frequently seen in public health, are an example of an adaptive complex organizational strategy. Leaders can also benefit from leaning on each other and seeking help and advice from people who have done similar work before them, such as STHO alumni. Leadership, especially during a pandemic, can be lonely and difficult work, and no one leader has all of the answers. We need to work together and share ideas and resources and look to our national associations such as ASTHO, NACCHO, and the Big Cities Health Coalition for collective strength. Finally, there is no better time than now to unite the polarities of science and politics. We cannot easily end this pandemic if we do not follow science and allow scientific principles to guide and inform the path forward, while acknowledging the inevitable political pressures of the job. While politics and science often conflict, effective leadership should be supported and sustained in the best interests of health officials and, even more importantly, the communities they serve.

BOOK REVIEW article Front. Public Health, 19 December 2014Sec. Public Health Education and Promotion Volume 2 - 2014 | https://doi.org/10.3389/fpubh.2014.00250

BackgroundMany low- and middle-income countries (LMICs) lack instruments to measure gaps in the public health competency of health professionals. The objective of this study is to develop a validated and reliable Core Public Health Competency (COPHEC) index by assessing the knowledge, skills, abilities, and attitudes of senior and mid-level public health professionals with supervisory and management responsibilities in Uttar Pradesh (UP), India.MethodsUsing the Core Competency framework that was developed in UP, we generated a draft COPHEC tool with 37 items, measured on a four-point Likert scale. We administered the tool to a total of 166 public health professionals that included two samples—84 senior and 82 mid-level public health professionals. To extract factors and assign factor scores to the instrument, we performed an exploratory factor analysis (EFA) using principal component analysis (PCA). Content and face validities were assessed by examining the steps used for the construction of the draft tool. Construct validity was measured by assessing the average factor loading of the items onto the component extracted from EFA. Internal consistency was used as a measure of reliability.ResultsThe final COPHEC index had 37 items loaded on one factor in the sample. Content and face validities were assured through a participatory process with relevant stakeholders who identified the initial set of items as part of a Core Competency framework. Construct validity of the COPHEC scale was confirmed by the high average factor loading of components ranging from 0.58 to 0.81. The final index showed adequate reliability with Cronbach’s alpha (α) = 0.97.ConclusionsThe COPHEC index is a valid and reliable measure of core competencies in public health in UP. We recommend that governments adapt the index in LMICs to conduct assessments of health workers to identify training needs, evaluate the effectiveness of training programs through participants’ competency acquisition pre- and post-training, and inform workforce development efforts in recruitment and performance management.

The American Association of Public Health Dentistry (AAPHD) was founded in 1937 with the mission of improving oral health. In 1950, AAPHD became the sponsoring organization of the specialty of dental public health. Since that time, AAPHD is recognized as the national leader in dental public health education. Through a grant awarded to AAPHD from the Health Resources and Services Administration titled Development and Implementation of a Model Curriculum for Pre-doctoral Dental Students to Acquire Competencies in Dental Public Health, the program directors, Dr. Ana Karina Mascarenhas and Dr. Kathryn Atchison and their team, identified eight core competencies in dental public health that describe the knowledge, skills, values, and behavioral objectives that each general dental and dental hygiene student should obtain in preparation for graduation and practice. Competency is defined by the AAPHD as “the level reached by the person who is initially a novice, and who, after training and experience, reaches the level where they can be competent” 1. For the specialist, this statement is defined as the “minimum knowledge, skills and values needed for an entry-level specialist to practice dental public health” 1. The competencies and the associated curriculum developed for the undergraduate student fulfill a similar competency definition with the focus on the knowledge, skills, and values needed for practice as a generalist in public health dentistry rather than a specialist. The competencies provide a foundation upon which the curriculum could be developed and educational planning would arise 2. Framed by the eight core competencies, a curriculum was developed, and modules were generated that addressed each statement. The program directors piloted the six modules that addressed 23 themes. A national speaker's bureau, which will be available on the AAPHD website, was created to identify speakers with expertise in the targeted areas of competency. Through this process, Dr. Mascarenhas and Dr. Atchison created an innovative and comprehensive model that can be adapted and adopted to educate students enrolled in dental and dental hygiene program across the United States. As president of AAPHD, it is my goal that this set of competencies and curriculum act as a stimulus to dental schools and dental hygiene programs to begin to address the notable oral health disparities and limitations in access to dental care. The curriculum that was developed will be distributed by AAPHD to dental and dental hygiene programs who are interested in integrating the model through the Association's website. As envisioned by AAPHD, this novel approach to delivering educational content can be utilized by universities and academic programs that do not have existing faculty expertise in dental public health. The curriculum provides dental and dental hygiene students with foundational knowledge in the science of dental public health and can be presented by experts in the subject area who are a part of the speaker's bureau. The depth and breadth of the curriculum allow for other creative applications to multiple learning groups. The final tool can be used to expand the knowledge, skills, attitudes, and values of students who want to learn about dental public health as an undergraduate dental or dental hygiene student, for the practitioner who wants to learn more about dental public health in the workplace, or for the master's level student who anticipates a career in public health dentistry. The modules can be used as a component of a bachelor's completion or master's level program in dental hygiene. In addition, the curriculum can be used to supplement the education of individuals currently engaged in dental public health practice at either state or local government or at a community health center. The curriculum can be adapted to educate individuals to the basic or intermediate levels of competence 2. The AAPHD would be delighted to entertain proposals to improve the knowledge about dental public health among a variety of health-care professionals. There are various options for the curriculum to educate future practitioners in the art and science of dental public health. The competencies and curriculum developed from this work emphasize the role of AAPHD as an educational leader not only for the specialty of dental public health, but for the dental public health education of undergraduate dental and dental hygiene students. The author has no conflicts to disclose.

Evidence-based practice (EBP) is necessary for improving the quality of health care as well as patient outcomes. Evidence-based practice is commonly integrated into the curricula of undergraduate, postgraduate, and continuing professional development health programs. There is, however, inconsistency in the curriculum content of EBP teaching and learning programs. A standardized set of minimum core competencies in EBP that health professionals should meet has the potential to standardize and improve education in EBP. To develop a consensus set of core competencies for health professionals in EBP. For this modified Delphi survey study, a set of EBP core competencies that should be covered in EBP teaching and learning programs was developed in 4 stages: (1) generation of an initial set of relevant EBP competencies derived from a systematic review of EBP education studies for health professionals; (2) a 2-round, web-based Delphi survey of health professionals, selected using purposive sampling, to prioritize and gain consensus on the most essential EBP core competencies; (3) consensus meetings, both face-to-face and via video conference, to finalize the consensus on the most essential core competencies; and (4) feedback and endorsement from EBP experts. From an earlier systematic review of 83 EBP educational intervention studies, 86 unique EBP competencies were identified. In a Delphi survey of 234 participants representing a range of health professionals (physicians, nurses, and allied health professionals) who registered interest (88 [61.1%] women; mean [SD] age, 45.2 [10.2] years), 184 (78.6%) participated in round 1 and 144 (61.5%) in round 2. Consensus was reached on 68 EBP core competencies. The final set of EBP core competencies were grouped into the main EBP domains. For each key competency, a description of the level of detail or delivery was identified. A consensus-based, contemporary set of EBP core competencies has been identified that may inform curriculum development of entry-level EBP teaching and learning programs for health professionals and benchmark standards for EBP teaching.

Competencies ensure public health students and professionals have the necessary knowledge, skills, values, and behaviours to do their jobs effectively. Public health is a dynamic and complex field requiring robust competency statements and frameworks that are regularly renewed. Many countries have public health competencies, but there has been no evidence synthesis on how these are developed. Our research aim was to synthesize the extent and nature of the literature on approaches and best practices for competencies statement and framework development in the context of public health, including identifying the relevant literature on approaches for developing competency statements and frameworks for public health students and professionals using a scoping review; and, synthesizing and describing approaches and best practices for developing public health competency statements and frameworks using a thematic analysis of the literature identified by the scoping review. We conducted a scoping review and thematic analysis of the academic and grey literature to synthesize and describe approaches and best practices for developing public health competency statements and frameworks. A systematic search of six databases uncovered 13 articles for inclusion. To scope the literature, articles were assessed for characteristics including study aim, design, methods, key results, gaps, and future research recommendations. Most included articles were peer-reviewed journal articles, used qualitative or mixed method design, and were focused on general, rather than specialist, public health practitioners. Thematic analysis resulted in the generation of six analytical themes that describe the multi-method approaches utilized in developing competency statements and frameworks including literature reviews, expert consultation, and consensus-building. There was variability in the transparency of competency framework development, with challenges balancing foundational and discipline-specific competencies. Governance, and intersectoral and interdisciplinary competency, are needed to address complex public health issues. Understanding approaches and best practices for competency statement and framework development will support future evidence-informed iterations of public health competencies.