A Systematic Approach to Evaluating Public Health Training: The Obesity Prevention in Public Health Course Avia Mainor, MPH; Jennifer Leeman, DrPH, MDiv; Janice Sommers, MPH; Claire Heiser, MS, RD; Cecilia Gonzales, BA; Rosanne P. Farris, PhD; Alice Ammerman, DrPH, RD rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr

Objective: Public health practitioners require new knowledge and skills to address the multilevel factors contributing to obesity. This article presents the systematic approach the Center of Excellence for Training and Research Translation (Center TRT) used both to assess practitioners’ competencies to lead public health obesity prevention initiatives and to evaluate its annual, competency-based obesity prevention course. Design: In 2006, Center TRT identified priority public health competencies for obesity prevention and then planned 7 annual courses to address the priority competencies progressively over time. Each year, a longitudinal evaluation based on Kirkpatrick’s training evaluation framework was administered to course participants (n = 243) to assess perceptions of the course (daily), changes in self-reported competency (immediately pre- and postcourse), and course impact on practice over time (at 6 months). Results: Participants rated the course highly for quality and relevance. Although many participants reported low levels of confidence prior to the course, following the course, at least 70% reported feeling confident to perform almost all competencies. At 6-month follow-up, the majority of participants reported completing at least 1 activity identified during course action planning. Conclusions: We identified practitioners’ high-priority competency needs and then designed 7 annual courses to progressively address those needs and new needs as they arose. This approach resulted in trainings valued by practitioners and effective in increasing their sense of competence to lead public health obesity prevention initiatives. The course’s continuing impact was evidenced by participants’ high level of completion of

J Public Health Management Practice, 2014, 20(6), 647–653 C 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright 

their action plans at 6-month follow-up. Competency-based training is important to develop a skilled public health workforce. KEY WORDS: competency-based, evaluation, public health

practice, training

A growing body of evidence suggests that a range of environmental factors contribute to an increased risk for obesity.1,2 Among the factors contributing to obesity are increased access to energy-dense foods and beverages.3 In many parts of the country, this is coupled with limited access to places for physical activity such as recreation facilities, sidewalks, and bike paths.2 As part of a growing movement to prevent obesity, public health practitioners are being asked to lead and collaborate in efforts to change physical, economic, social, and communication environments.4-6 In doing this work, public health practitioners are collaborating with transportation, food Author Affiliations: Center for Health Promotion and Disease Prevention (Mss Mainor, Sommers, and Gonzales and Drs Leeman and Ammerman) and School of Nursing (Dr Leeman), University of North Carolina at Chapel Hill; and Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia (Ms Heiser and Dr Farris). This project has been funded in whole or in part with federal funds from the Centers for Disease Control and Prevention, Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases, Center of Excellence for Training and Research Translation (grant U48/DP001944). The authors have no conflicts of interest to declare. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (http://www.JPHMP.com). Correspondence: Avia Mainor, MPH, Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Blvd, CB# 7426, Chapel Hill, NC 27599 ([email protected]). DOI: 10.1097/PHH.0000000000000046

647 Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

648 ❘ Journal of Public Health Management and Practice distribution, public planning, and other nontraditional partners.2 Many practitioners lack the training and experience necessary to effectively promote, implement, evaluate, and sustain environmental change.7 Competency-based training programs can play an important role in developing public health practitioners’ skills and knowledge. Competency-based trainings are designed to increase the specific skills and knowledge needed for a task, such as public health obesity prevention.8 In this article, we report on the evaluation of the Center TRT’s training program for public health practitioners working in obesity prevention. We detail priority core competencies and how we have used those competencies to evaluate the impact of Center TRT’s annual Obesity Prevention in Public Health Course on practitioners’ competencies.

● The Need for Competency-Based Training Public health practitioners often come from multiple disciplines and may enter the public health field at different stages of their career.9 Some lack formal training in public health, and those who have degrees in public health often received limited training on how to approach environmental change. Recommended environmental change strategies for obesity prevention include increased access to healthier foods and beverages, promotion of healthier foods and beverages, enhanced infrastructure for active transportation (eg, bicycling and walking), and increased access to public transportation.5,6 To effect these types of changes, practitioners often need to engage stakeholders from multiple sectors that extend beyond public health’s traditional partners, for example, departments of transportation, city planners, and food distributors.2 Practitioners also need both to intervene at multiple levels within complex systems and to plan for synergies and/or conflicts as the actions of one sector, organization, or interest group intersect with the actions of others.10,11 One of public health’s central mandates is to “assure the conditions in which people can be healthy.”12 To fulfill this mandate, the public health workforce needs to develop a range of competencies required to lead and collaborate in environmental change initiatives. Both The Future of Public Health12 and Healthy People 202013 call for sustained workforce development to enhance practitioners’ competencies to meet the demands of emerging public health problems. These reports and others recommend designing trainings to target the gap between practitioners’ existing competencies and those they need in their current roles.13,14 Designing training to address gaps in competencies requires an understanding of the competencies needed for a particu-

lar job. By determining the competencies practitioners need to effectively perform their duties, it is possible to examine the current capabilities and qualifications of the workforce, identify gaps, and then design training to fill those gaps.15 By targeting specific competencies, trainers can make explicit the planned focus and expected outcomes of a training program.9

● Center TRT’s Obesity and Public Health Course In 2004, the Centers for Disease Control and Prevention (CDC) funded the Center of Excellence for Training and Research Translation (Center TRT) to provide in-person and distance training to public health practitioners working in state health departments’ nutrition, physical activity, and obesity programs nationwide. Center TRT worked with the CDC’s Division of Nutrition, Physical Activity, and Obesity to develop, implement, and evaluate a competency-based, in-person, 5-day Obesity Prevention in Public Health Course, which was conducted annually between 2005 and 2012, a 7-year period. The primary audience for the course was state health department staff working in nutrition, physical activity, and obesity programs. This article details the Center’s competency-based approach to evaluate each year’s Obesity Prevention in Public Health Course. Center TRT designed its course to incorporate adult learning principles by focusing on problems that are directly relevant to participants’ work, respecting and incorporating participants’ experience, using a diversity of approaches, and actively engaging participants throughout the training.16 The course incorporates plenary presentations, stories from the field, skill-building application sessions, and networking roundtables. In the morning, nationally known experts present plenary sessions that address core concepts. Following these presentations, public health practitioners present stories from the field designed to demonstrate application of core concepts in practice. In the afternoon, participants attend skill-building application sessions and networking roundtables. Participants select 1 of 4 or 5 skill-building tracks that they attend for 3 hours a day over 4 afternoons. The opportunity to select a skillbuilding track allows participants to customize the learning experience to their needs. Because the skillbuilding tracks include a total of 12 hours of training, they provide an opportunity for participants to apply new information and skills while problem solving with their peers and planning action steps to implement when they return to their states. At the end of each day, participants select 1 of 4 roundtable sessions, each with a focus on different aspects of topics covered during the

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A Systematic Approach to Evaluating Public Health Training

plenary sessions. The roundtable sessions encourage additional peer sharing and relationship building among participants.

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following training to demonstrate the value of the training through changes in public health practice.

Participants

● Designing the Course to Address Priority Competencies To identify priority training needs, the team consolidated existing lists of competencies17-19 and then surveyed practitioners to identify those for which they had low levels of confidence and a high need for training. The survey was completed by 36 state-level nutrition, physical activity, and obesity program staff members, a 43% response rate. The 16 public health practice competencies that respondents rated as both high need and low confidence to perform are listed in Supplemental Digital Content Table 1 (available at: http://links.lww.com/JPHMP/A73). In collaboration with an expert panel, the content of each year’s course was planned so that all high-priority competencies would be addressed over time by focusing on a different subset of competencies each year. The multiyear plan targeted competencies for specific job roles within the state nutrition, physical activity, and obesity programs (ie, program coordinators or nutrition coordinators, etc). Over the years, course participants became more diverse in their job roles and years of experience working in obesity prevention (see Supplemental Digital Content Table 2, available at: http://links.lww.com/JPHMP/A74). To meet their ongoing training needs, we refined the competencies selected each year on the basis of findings from the previous year’s evaluations and recommendations from an expert advisory committee of practitioners and educational instructors. An overview of the competencies that the Obesity Prevention in Public Health Course addressed each year from 2006 to 2012 is provided in Supplemental Digital Content Table 1 (available at: http://links.lww.com/JPHMP/A73).

The evaluation was administered to the practitioners and CDC training fellows who attended the course from 2006 to 2012. Course attendance ranged from 43 in 2006 to a high of 67 in 2010 and included participants from 48 states and the District of Columbia (see Table 1). Most participants were public health practitioners working as program managers; nutrition, physical activity, or worksite wellness coordinators; or evaluators in their state public health departments (see Supplemental Digital Content Table 2, available at: http://links.lww.com/JPHMP/A74).

Evaluation instruments Daily, end-of-course, and pre-/postcourse surveys were administered using coded, scannable evaluation instruments tailored from previous training institutes. The 6-month follow-up evaluation was administered via an electronic survey. The daily and end-of-course surveys were administered to all participants, whereas the pre-/postcourse and 6-month follow-up surveys were administered only to practitioners and not to CDC training fellows.

Daily evaluation Daily evaluations captured satisfaction with teaching strategies, course content, and quality of presenters to help determine whether session objectives were clearly met. Participants evaluated each session on its (a) organization and presentation of material, (b) use of facilitation and teaching techniques, (c) relevance to their work, (d) appropriate allotment of time, and (e) overall value based on 5-point Lickert scales. Participants were encouraged to include additional comments.

End-of-course evaluation

● Design: Training Evaluation The Center TRT used a longitudinal survey design to evaluate each year’s Obesity Prevention in Public Health Course. The evaluation was based on Kirkpatrick’s training evaluation framework20 and assessed the (1) strengths and weaknesses of course components and organization, (2) effect of the course on participants’ confidence, and (3) impact of the course over time on practitioners’ work in the field. Components of the evaluation were administered daily during training, immediately pre- and posttraining, and 6 months

At the end of the course, participants evaluated the strengths and weaknesses of course components and organization, the extent to which course objectives were met, and whether they would recommend the course to their colleagues. Specific questions included how well course sessions fit together, whether participants’ expectations were met, and how they would rate the pace of the course. Participants were asked to rate the balance (too few, good balance, or too many) of the major course components, plenary presentations, skillbuilding, and application sessions to determine satisfaction with various aspects of the course.

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650 ❘ Journal of Public Health Management and Practice TABLE 1 ● End-of-Course Evaluations 2006-2012

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Obesity Prevention Course Year

No. Course Participants Year

No. (%) Completed Evaluations

% Rating Overall Quality of the Course as Good or Excellent

% Rating Content as Relevant or Very Relevant

43 45 45 51 67 56 58

42 (98) 32 (71) 38 (84) 40 (78) 55 (82) 44 (79) 52 (90)

95 91 90 95 98 100 98

98 84 87 93 76 98 94

2006 2007 2008 2009 2010 2011 2012

Competency self-assessment The self-assessment was administered both pre- and postcourse to assess change in participants’ confidence to perform the identified set of competencies addressed in that year’s course. During registration, participants received a 1-page precourse competency assessment form that they completed and turned in prior to the first session. Participants assessed themselves on each of the course competencies using a 5-point Likert scale, with 1 being “not confident” to 5 being “very confident.” Immediately following the completion of the course, participants were asked to repeat the self-assessment.

Six-month follow-up survey During the course, participants were asked to develop individual action plans that described 3 concrete steps they would take to apply information gained through the course. Planned action steps included, for example, reviewing other states’ successful vending machine initiatives or developing a communication plan for their states’ nutrition, physical activity, and obesity program. The plans were collected on the last day of the course, and an electronic PDF copy was sent to participants. Six months following the course, a Center TRT staff member e-mailed participants inviting them to complete an online survey to assess whether they had completed each of the 3 steps outlined in their plans. If they had not completed the steps, they were asked whether they were in progress, whether they no longer planned to take that action, and what additional tools or resources would be helpful to them in completing the steps.

● Results Overall course evaluation As detailed in Table 1, the end-of-course evaluation completed by participants ranged from 71% to 98%, and each year, at least 90% of respondents rated the

overall quality of the course as good or excellent, with percentages ranging from 90% in 2008 to 100% in 2011. The majority of participants also rated course content as relevant or very relevant; however, ratings were more variable from year to year than they were for course quality, ranging from 76% in 2010 to 98% in 2006 and 2011.

Changes in participants’ competency self-assessment As detailed in Table 2, prior to the start of the training, only a minority of participants rated themselves as either confident or very confident in their ability to perform most of the competencies targeted by that year’s course. The proportion of participants who rated themselves as confident or very confident was consistently lowest for the following 4 competencies: r Assess the potential public health impact of an intervention based on its reach, effectiveness, adoption, implementation, and maintenance. r Use principles of media advocacy to educate decision makers and the public on approaches that support health and reduce risk. r Consider the impact of decisions, programs, and policies on health disparities, including unintended consequences. r Work with communities to build capacity and infrastructure to address prevention of obesity and other chronic diseases. The average percentage of participants rating themselves as confident or very confident to perform competencies increased substantially immediately following the 5-day course. With only one exception, the majority, and in most cases more than 70%, of participants felt confident or very confident to perform competencies following the course. The competencies for which participants reported the lowest average levels of posttraining confidence reported in Table 2 were media advocacy (59.9%), educating on the development of policy

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A Systematic Approach to Evaluating Public Health Training

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TABLE 2 ● Average Proportion of Participants Reporting Confident or Very Confident in Competencies Across

Assessment Years 2006-2012 qqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq Assessment Years

Average Pre (%)

Average Post (%)

% Change

2006, 2007, 2008

27.2

77.0

49.8

2006

66.7

94.1

27.4

2006, 2007, 2008, 2010, 2011, 2012

52.7

84.1

31.4

2006, 2007, 2008

41.2

77.8

36.6

2006, 2007, 2008, 2010

18.3

59.9

41.6

2006, 2008, 2009, 2011, 2012

40.5

80.0

39.5

2007, 2008, 2010, 2011, 2012

41.1

80.1

39.0

2008

30.0

76.3

40.3

2008, 2010, 2011, 2012

44.6

80.4

35.8

2006, 2007, 2008, 2010, 2011, 2012

43.0

82.0

39.0

2009

61.4

82.9

21.5

2009, 2010, 2011, 2012

34.0

72.1

38.1

2009, 2010, 2011, 2012

40.4

81.5

41.1

2009

60.3

87.1

26.8

2010, 2011, 2012

25.1

74.2

49.1

Competency Assess the potential public health impact of an intervention based on its reach, effectiveness, adoption, implementation, and maintenance. Identify the role of cultural, social, and behavioral factors in determining the delivery of public health interventions and/or services Use evidence-informed nutrition and physical activity approaches in developing and/or implementing multilevel interventions Apply appropriate theories, models, and frameworks to select strategies and design and implement interventions Use principles of media advocacy to influence policy makers and public opinion and encourage social change Lead efforts to change social systems in support of healthy eating, physical activity and chronic disease prevention Engage critical stakeholders in the planning, implementation, and evaluation policies and interventions Work with communities to build capacity and infrastructure to address prevention of obesity and other chronic diseases Develop participatory and collaborative partnerships with communities using a variety of formal and informal mechanisms to inform program design and implementation Work with communities to change organizations, policies, and environments for prevention and control of obesity and other chronic diseases Create and communicate a shared vision, mission, and core values for groups, organizations, and communities Educating on development of formal and informal policy related to obesity prevention in states, communities, and organizations. Apply concepts of systems thinking to develop/implement obesity prevention interventions at the state and/or community level Collaborate with traditional and nontraditional partners to implement and maintain interventions Consider the impact of decisions, programs, and policies on health disparities, including unintended consequences

(72.1%), and considering impact on health disparities (74.2%).

Follow-up survey and progress on action plans The percentage of participants completing action steps following the training varied each year. However, at 6-month follow-up, the majority of participants

reported that they had completed at least 1 of the 3 action steps they planned during the course. Table 3 demonstrates a range of participants (47% in 2007 to 75% in 2010) completing at least 1 action step. A substantial number of participants completed all 3 steps, ranging from 32% in 2007 to 58% in 2011. Every year at least 42% of

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652 ❘ Journal of Public Health Management and Practice TABLE 3 ● Six-Month Follow-up Evaluation Results

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Year (n) 2006 (n = 28 of 43) 2007 (n = 35 of 45) 2008 (n = 31 of 45) 2010 (n = 52 of 67) 2011 (n = 44 of 56) 2012 (n = 39 of 58)

Completed 1 Step

Completed 2 Steps

Completed 3 Steps

70% 47% 52% 75% 69% 64%

68% 42% 42% 63% 64% 62%

56% 32% 39% 35% 58% 49%

participants completed 2 of their planned action steps by 6-month follow-up.

● Discussion In a recent review of the literature, Brownson and colleagues8 identified workforce training as one of public health’s high-priority administrative evidencebased practices. This evaluation provides support for the value of Center TRT’s approach to competencybased training in obesity prevention. Center TRT uses a systematic process to ensure that training effectively meets the needs of its primary audience, state-level public health practitioners working in CDC-funded nutrition, physical activity, and obesity programs. The great majority of participants rated the course favorably both for its quality and for its relevance to their current work, and the majority reported taking action on 1 or more of the activities they planned during the course. Evaluation findings suggest that the competencies targeted by each year’s course were areas where public health practitioners’ levels of confidence were low and that the course was effective in raising confidence levels. Center TRT’s approach to training differs from courses that apply a standard curriculum each year to develop competence in more general evidence-based public health practice. In contrast, Center TRT provides new course content each year and focuses on more advanced competencies in a specific area of public health practice—obesity prevention. The Center chose its approach on the basis of recommendations from its expert panel of practitioners, educators, and researchers, who advised that most of the trainings and conferences practitioners attend consistently focus on broad, foundational topics. Participants’ positive ratings and increased confidence attest to the success of Center TRT’s approach. Designing a new course each year and delivering it via an in-person format are more resource-intensive than using a standard curriculum or using online or webinar formats. The additional investment in devel-

oping a new course each year is necessary both to keep content current with the rapidly advancing field of obesity prevention and to progressively build practitioners’ competencies. The additional investment in travel and housing required to deliver the course in-person allows extensive peer networking and mentoring, a product of bringing practitioners into a single setting for 5 days and nights. The courses’ primary target audience is relatively small; fewer than 200 practitioners work in state nutrition, physical activity, and obesity programs. These practitioners work in an emerging field in which they are among the leaders in developing and evaluating new approaches to changing environments at the state and territory levels. By creating a venue in which 40 to 50 of these practitioners live, work, and learn together, Center TRT’s weeklong training facilitates the development of networks through which practitioners share their knowledge and experience both during and after the course. Additional research is needed to evaluate the costs and benefits of different training approaches.21 Center TRT’s emphasis on providing more advanced content is challenging because course participants have varying levels of experience and training. We use several strategies to bring all participants to a necessary level of baseline competency prior to the course. Center staff send participants articles to read prior to the course and may recommend that they take one of the Center’s online modules, which are designed to provide foundational information on nutrition, physical activity, and obesity. Center TRT’s efforts are not always sufficient, and differing levels of baseline competence may account for the variability in participants’ ratings of course relevance. In the year (2010) when the fewest participants rated the course as relevant, many were also inexperienced; 47% had less than 4 years of experience working in public health and 28% had less than 1 year of experience. The first year the course was offered, more than 80% of participants had less than 4 years of experience working in obesity prevention. By 2011, the percentage of practitioners with less than 4 years of experience and more than 4 years of experience was closer to half (see Supplemental Digital

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A Systematic Approach to Evaluating Public Health Training

Content Table 2, available at: http://links.lww.com/ JPHMP/A74; 47.0% more than 4 years; 53.1% less than 4 years). The Center’s approach to evaluation is limited in that it relies on practitioners’ self-report of change in competencies and of actions taken 6 months following the course. Future research is needed to assess the impact of training on the quality of practitioners’ intervention planning and implementation of interventions, as compared with practitioners who did not take the course. Although response rates were high at the end of the course and at 6-month follow-up, nonrespondents might have differed from respondents, thereby biasing the results. With the increasing shift in emphasis from interventions focused at individual behavior change to more environmental-level approaches, there is a need for training to expand practitioners’ skill sets and develop competency in unfamiliar areas. Continually assessing the needs of staff is also important to ensure that training content and formats keep pace with the rapidly changing field of obesity prevention. Center TRT’s approach to training offers one model for designing and evaluating competency-based training. REFERENCES 1. Sallis JF, Glanz K. Physical activity and food environments: solutions to the obesity epidemic. Milbank Q. 2009;87(1):123154. 2. Institute of Medicine. Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making. Washington, DC: National Academies Press; 2010. 3. Swinburn B, Sacks G, Hall K, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011;378:804-814. 4. Pomeranz JL. The unique authority of state and local health departments to address obesity. Am J Public Health. 2011;101(7):1192-1197. 5. Khan LK, Sobush K, Keener D, et al. Recommended community strategies and measurements to prevent obesity in the United States. MMWR Recomm Rep. 2009;58(RR-7): 1-26. 6. Brennan L, Castro S, Brownson RC, Claus J, Orleans CT. Accelerating evidence reviews and broadening evidence standards to identify effective, promising, and emerging policy and environmental strategies for childhood obesity prevention. Annu Rev Public Health. 2011;32:199-223. 7. Gantner LA, Olson CM. Evaluation of public health professionals’ capacity to implement environmental changes supportive of healthy weight. Eval Program Plann. 2012;35(3): 407-416.

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8. Brownson RC, Allen P, Duggan K, Stamatakis KA, Erwin PC. Fostering more-effective public health by identifying administrative evidence-based practices: a review of the literature. Am J Prev Med. 2012;43(3):309-319. 9. Koo D, Miner K. Outcome-based workforce development and education in public health. Annu Rev Public Health. 2010;31:253-269; 1 p following 269. 10. Hammond RA. Complex systems modeling for obesity research. Prev Chronic Dis. 2009;6(3):A97. 11. Institute of Medicine. Accelerating Progress in Obesity Prevention. Washington, DC: National Academies Press; 2012. 12. Institute of Medicine. The Future of Public Health. Washington, DC: National Academies Press; 1988. 13. US Department of Health and Human Services. HealthyPeople.gov. 2020 Topics & Objectives. Washington, DC: US Department of Health and Human Services; 2013. http://www.healthypeople.gov/2020/topicsobjectives2020 /overview.aspx?topicid=35. Accessed April 12, 2013. 14. O’Neall M, Brownson R. Teaching Evidenced-based public health to public health practitioners. Ann Epidemiol. 2005;15(7):540-544. 15. US Department of Health and Human Services. The Public Health Workforce: An Agenda for the 21st Century. Washington, DC: US Department of Health and Human Services. http:// www.health.gov/phfunctions/pubhlth.pdf. Accessed April 12, 2013. 16. Bryan RL, Kreuter MW, Brownson RC. Integrating adult learning principles into training for public health practice. Health Promot Pract. 2009;10(4):557-563. 17. Centers for Disease Control and Prevention, the Health Resources and Services Administration, and the Public Health Foundation. The Council on Linkages Between Academia and Public Health Practice, Core Competencies for Public Health Professionals. Washington, DC: Public Health Foundation; 2001. http://www.trainingfinder.org/ competencies/list_levels.htm. Accessed March 2006. 2010 revision available at: http://www.phf.org/resourcestools/ Documents/Core Competencies for Public Health Professionals 2010May.pdf. 18. Association of Schools of Public Health. Master’s degree in Public Health Core Competencies (version 1.3). http://www. asph.org/competency. Accessed February 2006. Final 2006 version available at: http://www.asph.org/publication/ MPH Core Competency Model/index.html. 19. Mixon H, Dodds J, Haughton B. Guidelines for Community Nutrition Supervised Experiences. 2nd ed. Chicago, IL: Public Health/Community Nutrition Practice Group, American Dietetic Association; 2003. 20. Kirkpatrick DL. Evaluating Training Programs: The Four Levels. San Francisco, CA: Berrett-Koehler Publ Inc; 2006. 21. Dreisinger M, Leet TL, Baker EA, Gillespie KN, Haas B, Brownson RC. Improving the public health workforce: evaluation of a training course to enhance evidence-based decision making. J Public Health Manag Pract. 2008;14(2):138-143.

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A systematic approach to evaluating public health training: the obesity prevention in public health course.

Public health practitioners require new knowledge and skills to address the multilevel factors contributing to obesity. This article presents the syst...
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