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

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.

Introduction Pharmaceutical Public Health (PPH) is defined as “the application of pharmaceutical knowledge, skills and resources to the science and art of preventing disease, prolonging life, promoting, protecting and improving health for all through organised efforts of society”.1 In the UK (and globally) pharmacy professionals (PPs) contribute to the delivery of local and national public/population health (PH) interventions.2,3 However, little is known to what extent PPs have specialist/advanced roles within PH practice. Aim The mixed methods review, commissioned by the UK Chief Pharmaceutical Officers in 2020, aimed to explore PPs’ specialist PH contributions including barriers and opportunities. Methods Databases available through PubMed were searched to retrieve articles published in English (2011- 2021) on seven topics including: emergency preparedness resilience and response (EPRR); integrating pharmacy to better support public health protection and improvement goals; public health skills and mitigating health inequalities. Two independent electronic surveys were developed, piloted and deployed for pharmacy and public health specialists via email cascade and social media. The surveys explored the extent to which PPs are involved in PH roles including the barriers and opportunities. Descriptive statistics summarised the data, and open-ended responses were themed. The NHS Health Research Authority tool identified this project did not require ethical approval as the surveys were service evaluation. Results Rapid Evidence reviews: Following assessment of 2,542 articles, 448 evidence statements were extracted from 135 relevant articles. They were predominantly from USA (39%) and UK (29%), with fewer high-quality reviews (17) or guidance (12), than moderate/low-quality reviews (42), single studies (33), or quantitative research (33). Common themes of PPs’ contributions included: surveillance and intelligence gathering; advocacy for their communities; signposting; delivery of health improvement and protection services; supporting people with long-term-conditions; and EPRR. Barriers identified included: limited public and professional awareness of pharmacy’s contribution to public health and under-resourced PH training. Pharmacy and PH professionals Surveys: There were UK-wide responses from 128 PPs and 37 PH specialists. Opportunities identified by PPs included: PH areas they directly contribute to (45%); qualifications, knowledge and skills (27%); strategic position in the community (19%), recent changing health landscape (4%). Barriers included lack of defined career pathway (20%); poor professional recognition (18%); limited resources (16%); lack of training and support (15%) and organisational and structural barriers (10%). PH specialists identified at least 12 areas from the Faculty of PH’s functions and standards, they believed additional benefits would be realised by PPs working directly within PH teams. Although only 40% PH specialists had PPs working within their teams, 83% stated that it would be beneficial or very beneficial to have PPs specialising in PH. Discussion/Conclusion Dedicated PPH training and system-wide leadership are required to fully realise population-level benefits. Low responses to the surveys present a study limitation, however, there was consensus from the themes emerging from both surveys and rapid evidence reviews findings. Pharmacy professionals make specialist contributions to PH despite barriers. Further investigation is required to identify how best to deploy advanced PPH resources. Future qualitative studies should be considered.

BackgroundThe number of Master of Public Health (MPH) programmes in low- and middle-income countries (LMICs) is increasing, but questions have been raised regarding the relevance of their outcomes and impacts on context. Although processes for validating public health competencies have taken place in recent years in many high-income countries, validation in LMICs is needed. Furthermore, impact variables of MPH programmes in the workplace and in society have not been developed.MethodA set of public health competencies and impact variables in the workplace and in society was designed using the competencies and learning objectives of six participating institutions offering MPH programmes in or for LMICs, and the set of competencies of the Council on Linkages Between Academia and Public Health Practice as a reference. The resulting competencies and impact variables differ from those of the Council on Linkages in scope and emphasis on social determinants of health, context specificity and intersectoral competencies. A modified Delphi method was used in this study to validate the public health competencies and impact variables; experts and MPH alumni from China, Vietnam, South Africa, Sudan, Mexico and the Netherlands reviewed them and made recommendations.ResultsThe competencies and variables were validated across two Delphi rounds, first with public health experts (N = 31) from the six countries, then with MPH alumni (N = 30). After the first expert round, competencies and impact variables were refined based on the quantitative results and qualitative comments. Both rounds showed high consensus, more so for the competencies than the impact variables. The response rate was 100%.ConclusionThis is the first time that public health competencies have been validated in LMICs across continents. It is also the first time that impact variables of MPH programmes have been proposed and validated in LMICs across continents. The high degree of consensus between experts and alumni suggests that these public health competencies and impact variables can be used to design and evaluate MPH programmes, as well as for individual and team assessment and continuous professional development in LMICs.

BackgroundEnsuring the current public health workforce has appropriate competencies to fulfill essential public health functions is challenging in many low- and middle-income countries. The absence of an agreed set of core competencies to provide a basis for developing and assessing knowledge, skills, abilities, and attitudes contributes to this challenge. This study aims to identify the requisite core competencies for practicing health professionals in mid-level supervisory and program management roles to effectively perform their public health responsibilities in the resource-poor setting of Uttar Pradesh (UP), India.MethodsWe used a multi-step, interactive Delphi technique to develop an agreed set of public health competencies. A narrative review of core competency frameworks and key informant interviews with human resources for health experts in India were conducted to prepare an initial list of 40 competency statements in eight domains. We then organized a day-long workshop with 22 Indian public health experts and government officials, who added to and modified the initial list. A revised list of 54 competency statements was rated on a 5-point Likert scale. Aggregate statement scores were shared with the participants, who discussed the findings. Finally, the revised list was returned to participants for an additional round of ratings. The Wilcoxon matched-pairs signed-rank test was used to identify stability between steps, and consensus was defined using the percent agreement criterion.ResultsStability between the first and second Delphi scoring steps was reached in 46 of the 54 statements. By the end of the second Delphi scoring step, consensus was reached on 48 competency statements across eight domains: public health sciences, assessment and analysis, policy and program management, financial management and budgeting, partnerships and collaboration, social and cultural determinants, communication, and leadership.ConclusionsThis study produced a consensus set of core competencies and domains in public health that can be used to assess competencies of public health professionals and revise or develop new training programs to address desired competencies. Findings can also be used to support workforce development by informing competency-based job descriptions for recruitment and performance management in the Indian context, and potentially can be adapted for use in resource-poor settings globally.

Digital Public Health stands for the integration and use of digital tools, automation, use of modelling and prediction, and personalisation and precision into public health services that build on improved access to health data and analytics. To capitalise on the opportunities that digital transformations offer to the mission of public health, the public health workforce needs education and training to develop the relevant digital competencies. With few exceptions, however, digital skills still need to become a routine part of public health training. Barriers to incorporating digital public health in public health training include uncertainty about what to teach, how to teach it, and who to teach it to. Firstly, digital competencies in public health are an evolving concept, making it challenging for education designers to make the necessary changes to public health curricula. Secondly, public health programmes already incorporate considerable subject matter, making the simple addition of content challenging. Finally, the rapid development of digital technologies requires us to find ways to develop closer collaboration with experts in information and communication technologies. Across Europe, experience in overcoming these barriers is emerging. This session will examine current developments in digital public health education and training and craft a roadmap for effectively including digital public health in public health training across Europe. The workshop will feature presentations of recent or ongoing research projects in which the speakers examine efforts to define a generic set of digital competencies for public health training in Europe. The presentations will include insights from a scoping review of international guidance on digital competencies for public health practice, two Delphi studies defining digital competencies for general public health education in Germany and in Europe, expert guidance for public health schools on integrating digital competencies into curricula, and a mapping of training experiences in a course on digital health literacy for public health professionals. An interactive discussion will follow, during which the presenters and participants will critically examine the emerging set of digital competencies for public health education and discuss potential next steps for implementation. Workshop participants will leave the workshop with an in-depth understanding of the current progress and outstanding challenges in incorporating digital competencies in public health education and training across Europe. Key messages • Digital competencies are a critical component of 21st-century public health, but uncertainty about what to teach, how to teach it, and to whom to teach it needs to be addressed. • This workshop will examine progress in defining digital competencies for public health and craft a roadmap for effectively including digital skills in public health training and education in Europe.

Effective and precise public health practice relies on a skilled and interdisciplinary workforce equipped with integrated knowledge, values, skills, and behaviors as defined by competency frameworks. Competency frameworks inform academic and professional development training, support performance evaluation, and identify professional development needs. The aim of this research was to systematically identify and examine trends in the extent, nature, and range of the literature related to developing competencies in public health. This includes developing public health competency frameworks, and how competencies are developed and maintained in students and practitioners. We used a scoping review methodology to systematically identify and report on trends in the literature. Two independent reviewers conducted title and abstract and full-text screening to assess the literature for relevance. Articles were included if they were original primary research or gray literature and published in English. No date or geographic restrictions were applied. Articles were included if they focused on developing competency statements or frameworks for public health and/or training public health students or practitioners to develop competencies. The review encompassed a range of methods and target populations, with an emphasis on building competencies through student and professional development. Foundational competency development was a primary focus, and we found a gap in discipline-specific competency research, especially within developing discipline-specific competency statements and frameworks. Several evidence-based practices for competency development were highlighted, including the importance of governance and resources to oversee competency framework development and implementation, and workforce planning. Experiential learning and competency-based training were commonly identified as best practices for building competencies. A comprehensive understanding of public health competency development—through developing and incorporating foundational and discipline-specific competencies, mapping student and practitioner training to competency frameworks, and incorporating best practices—will enable public health to create skills and an adaptable workforce capable of addressing complex public health issues.

Entry-to-practice public health nursing competencies: A Delphi method and knowledge translation strategy

Identifying Public Health Competencies Relevant to Family Medicine

BackgroundProfessional development of public health leaders requires a form of instruction which is competency-based to help them develop the abilities to address complex and evolving demands of health care systems. Concurrently, emotional intelligence (EI) is a key to organisational success. Our aim was twofold: i) to assess the relationship between the level of self-assessed public health and EI competencies among Master of European Public Health (MEPH) students and graduates at Maastricht University, and; ii) to determine the relationship between different groups of public health competencies and specific EI skills.MethodsA cross-sectional study was conducted including all recent MEPH graduates and students from 2009–2012, out of 67 eligible candidates N = 51 were contacted and N = 33 responded (11 males and 22 females; overall response: 64.7%).Two validated tools were employed: i) public health competencies self-assessment questionnaire, and; ii) Assessing Emotions Scale.ResultsFemales scored higher than males in all seven domains of the self-assessed key public health competencies (NS) and emotional intelligence competences (P = 0.022). Overall, the mean value of public health competencies was the lowest in students with “staff” preferences and the highest among students with mixed job preferences (P < 0.001). There was evidence of a correlation between the overall public health competencies and the overall emotional intelligence competencies (r = 0.61, P < 0.001).ConclusionsThe study shows a positive correlation between public health specific competencies and EI attributes. It can contribute to the improvement of the educational content of PH curricula by rising awareness through self-assessment and supporting the identification of further educational needs related to leadership.

In the UK and globally, pharmacy professionals (pharmacists and pharmacy technicians) contribute to the delivery of local and national public or population health interventions. The existing literature on pharmaceutical public health predominantly focuses on micro-level activities, primarily describing community pharmacies delivering public health interventions to individuals. There is little-known evidence on pharmacy professionals' involvement in delivering public health interventions at meso- (e.g., organisational) and macro (national/policy) levels, nor to what extent pharmacy professionals have specialist/advanced roles within public health practice. This study specifically explored pharmacy professionals' specialist/advanced roles within public health as well as the opportunities and barriers to career development. The analyses of this mixed-methods study makes a series of important recommendations for future action. This study included two independent cross-sectional electronic surveys for pharmacy professionals and public health professionals, a call for evidence, and two workshops to develop recommendations. Pharmacy professionals (n = 128) and public health professionals (n = 54) across the UK participated in the surveys. Most of the Pharmacy Professionals respondents were female (70%), pharmacists (85%), working in primary (33%) or secondary (25%) care settings, mainly based in England (75%), and most (63%) lacked formal public health qualifications although they were involved in a diverse range of public health interventions. The public health professionals were mostly females (67%), practicing in England (58%). Both professional groups identified opportunities and barriers to pharmacy professionals' involvement in public health. Almost half of the public health professionals respondents (44%) stated that they had a pharmacy professional working as part of their current public health teams. Eighty-seven percent of public health professional respondents (45/52) agreed that having pharmacists or pharmacy technicians specialising in public health would be beneficial or very beneficial. Most of the documents, reports, and case histories provided through the call for evidence were unpublished. The workshops generated 94 recommendation statements, highlighting collaboration and the need to acknowledge pharmacy professionals' contributions to public health. The recommendations for strategic action at meso- and macro-levels included three main themes: adopting a national strategic approach to pharmaceutical public health, including improving commissioning; formalising pharmaceutical public health workforce development; and promoting further evidence-based pharmaceutical public health research and development.

An important workforce development effort during the past 25 years has been developing competency sets. Several of the sets rely on the concepts of Senge's Learning Organization and Burns' Transformational Leadership. The authors' experiences and study in designing and implementing a curriculum for a public health leadership institute based on these concepts raised several important questions about competency development and application. To summarize the use of the Senge and Burns frameworks in several competency sets and the practice literature and to assess the status of competency development for those frameworks and for competency development generally. The authors reviewed several commonly used competency sets and textbooks and searched 3 leading public health practice journals (Journal of Public Health Management and Practice, Public Health Reports, and American Journal of Public Health) for Senge and Burns framework terms. They also reviewed efforts to implement competency sets in public health education and practice. (1) The extent to which the articles and texts demonstrated understanding of the frameworks and reported their implementation and (2) whether competency statements and their uses in the literature contained precise definitions of competencies (knowledge, skills, behaviors, and attitudes associated with them), the standards by which competence is to be measured, and the means for measuring their attainment. "Learning Organization" and "Transformational Leadership" terms were used often and viewed favorably. However, the terms were rarely defined as Senge and Burns had, the uses generally did not indicate the complexity and difficulty of implementation, and there was only one report of even partial implementation. The review of competency development efforts found there is virtually no attention to the definitional and measurement issues in the literature. Unless public health organizations recognize the need for a common understanding of competencies and how to measure their attainment and act on that understanding, it will be impossible to say with confidence that there is agreement on which individuals are competent, whether public health agencies have competent personnel, or that the public health workforce itself is competent.

Background &amp; Aim: Nursing practice, characterized by its multifaceted nature, encompasses diverse settings and situations in public health, making it difficult to clearly define the role of nurses in this setting. The study aimed to determine the applicability and relevance of the Regional Core Competency Framework for Public Health in nursing practice during the COVID-19 pandemic. Methods &amp; Materials: Study based on the Delphi methodology, a structured approach to the systematic collectión of expert opinions, to obtain group agreements. Twenty-one nurses working in public health areas during the pandemic participated. Results: The competencies most applied by the nurses were in the domain of health situation analysis and surveillance and risk and damage control. 95% of the nurses were involved in care actions to prevent contagion; 71% analyzed social determinants of health, 100% were involved in the domain of policies, planning, regulation, and control, and 86% in the domain of health promotion. 89% made decisions to favor access to preventive and health care services. 78% valued social participation actions and 76% implemented immediate responses to COVID-19. Conclusion: The main public health competencies used by nursing for dealing with the COVID-19 pandemic are the management of educational processes, health promotion, primary health care, analysis of social determinants, management of health policies, information analysis, and management of immediate responses to challenges generated by COVID-19.

Since in his Viewpoint ‘Public Health competences: from potential to action,’ Anders Foldspang calls for ‘the continued discussion in the professional public health associations of European countries,’ I would like to put forward a few considerations related to the European Public Health Core Competencies Project (EPHCCP) which include (i) consensus, (ii) one size fits all, (iii) the need and (iv) public health leadership. Although the breadth and diversity of the public health workforce greatly contributes to the effective delivery of public health services, it also presents a formidable challenge for public health educators, leaders and public health workforce themselves, when it comes to state their identity. ASPHER’s EPHCCP and its subsequent phases constitute the set of consensus-driven competencies which can be used for the development of academic degrees in public health. By identifying these core competencies, ASPHER aims to raise the bar for consistent quality of public health education providing the guidance to the Schools and Departments of Public Health (SDPH) on how to highlight the credibility of their degrees. Since, this product constitutes a point of reference for public health discipline and academic support in the strive for professionalistaion, the question arises whether we have done enough …

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.

BackgroundResearch priority setting (RPS) studies are necessary to close the significant gap between the scientific evidence produced and the evidence stakeholders need. Their findings can make resource allocation in research more efficient. However, no general framework for conducting an RPS study among public health stakeholders exists. RPS studies in public health are rare and no such study has been previously conducted and published in Germany. Therefore, we aimed to investigate which research topics in public health are prioritised by relevant stakeholders in Germany.MethodsOur RPS study consisted of a scoping stage and a Delphi stage each split into two rounds. Firstly, we invited members of the German Public Health Association to gather expert insights during two initial workshops. Next, we defined the relevant stakeholder groups and recruited respondents. Thereafter, we collected research topics and assessment criteria with the respondents in the first Delphi round and aggregated the responses through content analysis. Finally, we asked the respondents to rate the research topics with the assessment criteria in the second Delphi round.ResultsIn total, 94 out of the 140 invited public health organisations nominated 230 respondents for the Delphi study of whom almost 90% participated in both Delphi rounds. We compiled a comprehensive list of 76 research topics that were rated and ranked by several assessment criteria. We split the research topics into two types, substantive research topics and methodological-theoretical research topics respectively, to ensure the comparability among the research topics. In both types of research topics—substantive research topics and methodological-theoretical research topics—the respective top five ranked research topics hardly differed between public health researchers and public health practitioners. However, clear differences exist in the priority ranking of many (non-top priority) research topics between the stakeholder groups.ConclusionsThis research demonstrates that it is possible, with limited resources, to prioritise research topics for public health at the national level involving a wide range of pertinent stakeholders. The results can be used by research funding institutions to initiate calls for research projects with an increased relevance for health and/or scientific progress.