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MCHES Exam 2023 With Questions and Correct Answers
Research - correct answer- can be conducted with the intent to generalize findings from a sample to a larger population. It does not always aim for, or achieve, evaluative conclusions, and it is restricted to empirical (rather than evaluative) data. Statement of Purpose - correct answer- Clearly and succinctly defines the goal of the project. Elements include research design (quantitative study) or method of inquiry (qualitative study); variables (quantitative) or phenomena under investigation (qualitative study); priority population; and research setting (worksite, university, etc) Systematic Reviews - correct answer- a published qualitative review of a comprehensive synthesis of publications on particular topics. Can be helpful in identifying current gaps in a stream of literature that can be filled in with new, data- based health education/promotion research. Meta-analyses - correct answer- A systematic statistical method of evaluating data based on numerical results of several independent studies of the same problem. Combining data from multiple sources. Pooled analysis - correct answer- A method for collecting all the individual data from a group of studies, combining them into one large set of data, and then analyzing the data as if it came from one big study. Capacity Assessment - correct answer- Measure of actual and potential individual, group, and community resources that can be inherent to and/or brought to bear for health maintenance and enhancement. Mapping community assets also included in this assessment. Needs Assessment - correct answer- Systematic identification of needs within a population and the determination of the degree to which those needs are being met. Qualitative Data - correct answer- Information that is difficult to measure, count, or express in numerical terms. Must be careful not to introduce bias May use interviews, observational research, case studies, content analysis, etc. Quantitative Data - correct answer- Information that can be expressed in numerical terms, counted, or compared on a scale. Must construct questionnaire items in such a way that the responses produce data that are reliable and valid. Primary Data - correct answer- Data gathered by health education specialists directly from or about the individual or population of interest. These data answer questions
related to the specific needs assessment. Collected by surveys, interviews, focus groups, and direct observation. Allows specialist to obtain accurate data about problems, influences, and potential solutions to health issues specific to the community. 20% attrition rate to account for no responses By convention, a significance value of 0.05 is used in health education/promotion research Secondary Data - correct answer- Data that have already been collected by others that may or may not be directly gathered from the individual or population being assessed. Examples: existing research published in peer-reviewed journals Sources include: CDC, MMWR, Behavior Risk Factor Surveillance System, YRBSS, vital records, US Census Bureau, health care system, state & local agencies, literature, etc. Stakeholders - correct answer- Individuals or agencies that have a vested interest in the health education program Social Determinants of Health - correct answer- Conditions in which people are born, live, work, play, and age that affect their health risks, health, daily functioning, and quality of life. Health disparities- differences in access to or availability of facilities and services Health inequities- are avoidable inequalities in health between groups of people within countries and between countries Epidemiological Method (needs assessment model) - correct answer- focuses on epidemiological data (death rates, prevalence rates, birth rates, etc.) Public Health Model (needs assessment model) - correct answer- Attempts to quantify health problems and often uses epidemiological data. This model can be more focused on a specific population and can be mindful of limitations of resources. Social Model (needs assessment model) - correct answer- Investigates social or political issues that influence health. Asset Model (needs assessment model) - correct answer- Focuses on the strengths of a community, organization, or population and looks to find ways to use existing assets to improve health. Rapid Model (needs assessment model) - correct answer- Is used when time and money are lacking for a needs assessment. Offers basic information, but is often lacking in detail. Needs Assessment Models - correct answer- Are not independent - you can use several at once.
Resource Sensitive - Resources are scarce Utilitarian - the greatest good for the greatest number; the end justifies the means Literature Review - correct answer- 1. Specify study aims. What questions do you want to answer?
- Set inclusion criteria. What evidence will address the question?
- Design the recruitment strategy. How will you find the evidence you want?
- Screen potential partners. What evidence from the search process meets your criteria?
- Decide on measures and design the data collection protocol. What characteristics will you code?
- Select an appropriate metric to represent the strength of the findings. How will you represent findings from individual studies?
- Collect the data. What are your coding procedures?
- Analyze and display the data using appropriate methods.
- Draw conclusions based on data and the limitations Surveys (individual data collection strategy) - correct answer- Used to determine knowledge, attitudes, beliefs, behaviors, skills & health status of priority population. Interviews (individual data collection strategy) - correct answer- Similar to surveys - conducted in a variety of ways. Can be completed by phone, face to face, electronically or in groups. Phone interviews offer a relatively easy method of collecting data at moderate cost. Web based also popular and inexpensive, however - access to limited population (only those with internet access), lack of anonymity, and emails can easily be ignored. Self-Assessment Instruments (individual data collection strategy) - correct answer- Can require people to answer questions about their health history, behavior, and screening results (BP, cholesterol, weight). Data is then compared against a database of individuals with similar characteristics, which provides a risk assessment for a number of diseases. Observations (group data collection strategy) - correct answer- Gather data through direct surveillance of the population i.e. watching factory workers for their use of PPE. Community Forum (group data collection strategy) - correct answer- Public meetings. They bring together people in a particular population to discuss perceptions of community's health problems. Remember - silent majority may not speak out, while more vocal individuals' views may wrongly be seen as group's views. Focus Group (group data collection strategy) - correct answer- Facilitator encourages the participants to talk to one another, ask questions, give examples, and provide comments regarding a particular topic. Can be as small as 2 people or as large as facilitator can handle. Analysis of results can be challenging.
Nominal Group Process (group data collection strategy) - correct answer- Highly structured process in which a few reps from the priority population are asked to respond to questions based on specific needs. Uses groups of 5-7, with each member having an equal voice. All participants share their opinions by privately ranking the ideas proposed, then sharing round-robin fashion. Time consuming process. Delphi Panel (group data collection strategy) - correct answer- Generates consensus by using a series of mailed or emailed questionnaires. Process involves individuals from 3 groups - decision makers, staff, and program participants. A questionnaire with 1 or 2 broad questions is sent to the entire group. Then answers are analyzed. Based on analysis, a second questionnaire with more specific questions is developed. This is sent to the same group of people, then repeat. On average, questionnaires are analyzed and sent out 3-5x. Community Capacity (community data collection strategy) - correct answer- Inventory and community asset maps are tools for identifying community resources and issues. Typically involves developing a written list of skills and talents of individual community members, associations, etc. Simple survey, interviews, community newspaper, etc are methods that can be used to gather info. A community asset map is a visual representation of the physical assets of a community that may constitute important physical and social structures for achieving community goals. Photo Voice (community data collection strategy) - correct answer- Specific photographic technique to enable people to record and reflect personal and community strengths & concerns Internal Review Board (IRB) - correct answer- functions to protect human subjects involved in research. Often referred to as "independent ethics committee". Missing data - correct answer- Are observations that were intended to be made, but were not made. Elaboration Likelihood Model - correct answer- finding out how much the audience cares about an issue; a person who feels directly impacted by a topic will be more likely to pay attention to a message and want the details Information Processing Theory - correct answer- Keep communications simple; include no more than 2-3 main messages; break information into small chunks Social Marketing Model - correct answer- HES listens to the needs and wants of a consumer by looking at a marketing mix; 4 P's Product - health behavior, program, or idea Price- financial, physical, psychological, time Place - how and where learning will take place
- Electioneering (contributing to the campaign of a candidate supportive of PH and HE.
- Direct lobbying (contacting a policy maker)
- Grassroots lobbying (town hall meetings, petition for a specific policy)
- Use of the internet to access info on health issues
- Media advocacy
- Social media Advocacy Plan - correct answer- 1. Goals
- Organizational considerations
- Constituents, allies, opponents
- Targets
- Tactics Good tool to utilize in development & implementation of advocacy plans is the Community Health Toolbox Advocacy Evaluation Resources - correct answer- Innovation Network The California Endowment The Evaluation Exchange Allocative policies - correct answer- Offer benefits to some distinct class of individuals; funding to support medical education or groups who are impoverished is an example Regulatory policies - correct answer- influence the actions and decisions of others. "Health in all policies" - correct answer- rationale is to develop a collaborative approach to addressing health through partnership of multiple sectors in the community Steps in policy making process - correct answer- 1. Formulation (program ID, agenda setting, selecting a policy solution, & drafting policy)
- Enactment
- Implementation(policy makers or actors guiding the implementation of policies and make it operational... setting up protocols, communications & enforcement)
- Maintenance/modification (policy becomes institutionalized. Prevalence Rate - correct answer- the number of cases of a disease that are present in a particular population at a given time Incidence Rate - correct answer- the number of new cases that develop in a given period of time Proportionate mortality ratio - correct answer- Number of deaths within a population due to a specific disease or cause divided by the total number of deaths in the population during a time period such as a year Case fatality rate - correct answer- the proportion of deaths within a designated population of "cases" (people with a medical condition) over the course of the disease;
calculated by dividing the number of deaths from a specified disease over a defined period of time by the number of individuals diagnosed with the disease during that time
Behavioral (lifestyle) factors - correct answer- behaviors or actions of individuals, groups, or communities. Behavioral indicators may include compliance, consumption, and utilization patterns, coping, preventive actions, and self care Environmental factors - correct answer- determinants outside the individual that can be modified to support behavior, health, and quality of life. Examples of environmental factors include economic factors, physical factors, and public services, as well as the accessibility, affordability, and equity of health services. 5 major factors that contribute to determinant of health of a population (conditions in which people are born, grow, live work, and age) - correct answer- 1. Genes & biology (sex, age, etc)
- Health behaviors (healthy eating, physical activity, alcohol use, injection drug use, unprotected sex, smoking)
- Social environment or social characteristics (discrimination, income, gender, and social support) - * big factor in determinant of health
- Physical environment or total ecology (where a person lives, crowding conditions, and built environments)* big factor in determinant of health
- Health services or medical care(access to quality health care and having/not having insurance) 5 key areas of social determinants of health - correct answer- 1. Economic Stability (poverty, employment, food security, housing)
- Education (high school graduation, enrollment in higher ed, language, literacy)
- Social & Community Context (social cohesion, civic participation, perceptions of discrimination & equity)
- Health & Health Care (access to health care and primary care, health literacy)
- Neighborhood and Built Environment (access to healthy foods, quality of housing, crime and violence) Health disparities - correct answer- a particular type of health difference that is closely linked with social, economic and/or environmental disadvantage Health equity - correct answer- attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequities, historical and contemporary injustices, and the elimination of health and health care disparities Conduct needs & capacity assessments to better understand influences on the health and well-being of individuals and groups - correct answer-
- Introduce any outside resources to fill gaps Program Prioritization - correct answer- Pg. 49 high changeability, highly important, less important, lesser changeability Vision Statement - correct answer- One sentence or one phrase statement that describes the long term desired change stemming from the efforts of an organization or program (Sample: To ensure that all children are physically fit and nutritionally fed in order to learn, play, and grow) A vision statement focuses on tomorrow and what an organization wants to ultimately become. Mission statement - correct answer- statement of the general focus or purpose of a program. A mission statement can be a one sentence statement or a short narrative that broadly defines the program's purpose. Mission statements identify the scope or focus of the organization or program and are enduring over time (Sample: The mission of the South County Senior Services is to provide easy access to health information and health care resources to senior citizens in South County) A mission statement focuses on today and what an organization does to achieve it. Goals - correct answer- General, long-term statements of desired program outcomes and provide the direction upon which all objectives are based (Sample: Reduce the number of osteoporosis-related fractures among elderly men and women who live in the area served by the health department) Objectives - correct answer- statements that describe, in measurable terms, the changes in behavior, attitude, knowledge, skills or health status that will occur in the intervention group as a result of the program. Objectives are small, specific steps that enable the goal to be met They should be: Clear statements Include just 1 indicator State reasonable time frames Be stated in terms of performance, not effort Be realistic Be relevant, logical, feasible, observable, measureable Community-based organization (CBO) - correct answer- a public or private, nonprofit organization of demonstrated effectiveness that is representative of a community or significant segments of a community and provides educational or related services to individuals in the community Expressed needs - correct answer- can be observed through individuals' use of services, such as an exercise class taken by older adults at a senior center
I.E. if more students sign up for an online course than the seat limit, administrators may start discussing the need for more sections and faculty Actual needs - correct answer- inferred through the discrepancy of services provided to one community group as compared to another, such as bicycling and walking lanes Perceived needs - correct answer- refers to what individuals in a community state that they want, such as more healthy food choices in a school vending machine Normative needs - correct answer- describe a discrepancy between an individual's or group's current status and that of others, such as smoke free environment in restaurants among different cities I.E. Normative needs exist if, for example, a student's score on the SAT is lower than the national standard or average or if general education courses at a college do not meet state requirements. Steps for an effective coalition - correct answer- 1. Analyze the issue or problem on which the coalition will focus
- Create awareness of the issue
- Conduct initial coalition planning and recruitment
- Develop resources and funding for the coalition
- Create coalition infrastructure
- Elect coalition leadership
- Create an action plan Primary prevention - correct answer- Focused on protecting people from developing a disease or injury (i.e. education about healthy diet) Secondary prevention - correct answer- emphasizes early diagnosis of disease or potential injury (i.e. might include recommending regular preventive exams or screening tests) Tertiary prevention - correct answer- focuses on rehabilitation after the diagnosis of a disease or injury - involve preventing further deterioration and maximizing quality of life Behavioral Objectives - correct answer- behaviors or actions that the population will engage in to resolve the problem and lead to attainment of the program goal. I.E. Among those attending the program, weight-bearing activity will increase by 50% over the following 6 months. Learning/Instructional Objectives (also referred to as impact objectives) - correct answer- Short-term, specific descriptions of awareness, knowledge, attitudes, and skills in relation to the content being taught. I.E. The participants will be able to correctly identify 3 forms of weight-bearing activity after the first session
Step 6: Plan evaluation Development (budgets, distribution, promotion plan; prototype products, services, communications; pretest; refine) Implementation (produce offerings/materials; coordinate w/ partners; implement intervention; process evaluation; refine offerings as needed) Assessment (conduct outcome evaluation; refine intervention as needed) CNHEO Belmont Report - correct answer- Code of Ethics HES are expected to follow Human subjects' protection establishes a standard for ethics, and details can be found in the Belmont Report Andragogy - correct answer- Adult learning Actively involve adults in entire process Ask about past experience and knowledge Use methods to help obtain problem solving skills rather than learning content Conduct assessments to ID ways to engage adults & learn their goals/objectives for the training Use a variety of methods, perspectives, and content Pedagogy - correct answer- Children's learning Asynchronous training - correct answer- distance learning in which training occurs outside of real time where the instructor and the learners communicate at different times Synchronous training - correct answer- distance learning in which training in real time and the instructor and the learners communicate at the same time Challenges to technical assistance - correct answer- Inadequate funding Managing the volume of TA requests person or organization's readiness to receive TA Evaluate Training - correct answer- Level 1: Reaction (participant satisfaction, Likert scale, open-ended questions); administered at the end of training Level 2: Learning (measures the amount of knowledge gained as a result of the training); pre & post tests Level 3: Behavior (conducted sometime after the training; surveys and interviews are often used) Level 4: Results (longer-range results that occurred due to the training); can have difficulty in showing that changes are directly due to a training Social Cognitive Theory - correct answer- Learning is an interaction between a person and his/her environment, cognitive processes, and behavior.
Referred to as a reciprocal determinism Major constructs of this theory: behavioral capability, expectations, expectancies, self- control, emotional coping responses, reciprocal determinism, and self-efficacy Transtheoretical Model - correct answer- Often called Stages of Change Model, incorporates components of many theories useful in that its planned interventions can reach people where they are in their motivation for a particular behavior Precontemplation: not interested in addressing problem Contemplation: Aware of there is a problem and intends to do something in the next 6 months Preparation: Has taken steps and plans to address problem in the next month Action: Person has changed behavior within the past 6 months Maintenance: Maintained behavior for more than 6 months Termination: Has no temptation to return to the old behavior Process of Change - help to explain HOW the changes occur Health Belief Model - correct answer- Individual-level model 6 major constructs thought to affect behavior change:
- Perceived susceptibility: a person feels at risk for the disease
- Perceived Severity: there are serious consequences to contracting the disease
- Perceived Benefits: there are benefits to taking action to prevent/control the disease
- Perceived Barriers: there are consequences to taking action against the disease
- Cues to action: cues or triggers that encourage a person to take action
- Self-efficacy: a person is confident in taking action against the disease Theory of Reasoned Action and Theory of Planned Behavior - correct answer- Both recognize behavioral intention as key in determining behavior and assume that behavior change is influenced by a person's attitude toward the outcome and the social or subjective norms of people important in their life Examine individuals motivation to perform the behavior, determine what the individuals peers think of the behavior, and assess the difficulty the individual will have in performing the behavior Diffusion of Innovations Theory - correct answer- Community-level theory Describes the rate at which a new program/activity will spread throughout a group of people Innovators are the first to adopt the new program Early adopters wait until after the innovators adopt Early majority adopts once the opinion leaders have done so Late majority adopts once the new idea or program become the norm Laggards are the last to adopt or may never adopt *Majority will fall in the middle categories (early & late majority); uses matrix mix; works best for behaviors not necessarily programs
- determines whether program activities have been implemented as intended.
- You may conduct process evaluation periodically throughout the life of your program and start by reviewing the activities and output components of the logic model *measures program reach and response Summative Evaluation - correct answer- Often associated with measures or judgments that enable the investigator to draw conclusions from impact and outcome evaluations
- the focus is on the outcome of a program Impact Evaluation - correct answer- Focuses on immediate and observable effects of a program leading to the desired outcomes Outcome Evaluation - correct answer- Focused on the ultimate goal, product or policy and is often measured in terms of health status, morbidity, and mortality. Evaluation Model - correct answer- Attainment - focused on program objectives and the program goals; serve as standards for evaluation Decision-Making - based on 4 components designed to provide the user with the context, input, processes, and products with which to make decisions Goal-free - not based on goals; evaluator searches for all outcomes including unintended positive and negative side effects Naturalistic - focused on qualitative data and uses responsive information from participants in a program; most concerned with narrative explaining "why" behavior did or did not change Systems Analysis - Based on efficiency that uses cost benefits or cost effectiveness analysis to quantify effects of a program Utilization-focused - done for and with a specific population Quasi-Experimental Study - correct answer- Non-randomized studies do not use random allocation of participation, and groups or individuals are assigned arbitrarily
- Ex post facto design is a quasi-experimental study examining how an independent variable, present prior to the study in the participants, affects a dependent variable. A quasi-experimental study simply means participants are not randomly assigned. Nonexperimental Design - correct answer- Cross-sectional; do not seek to manipulate any variables Attempt to describe feature of a priority population; least rigorous designs and do not control for many threats to internal validity Experimental design= most control over confounding variables Health Surveillance Programs - correct answer- Behavioral Risk Factor Surveillance Survey (BRFSS) - adults regarding their health-related risk behaviors, chronic health conditions, prevention Youth Risk Behavioral Surveillance System (YRBSS) - youth and young adults
National Youth Tobacco Survey (NYTS) - tobacco beliefs, attitudes, behaviors, exposure National Health and Nutrition Examination Survey (NHANES) - adults & children National Health Interview Survey Reliability - correct answer- Can range from 0 to 1 - 0 representing an instrument full of error and 1 representing total absence of error. A reliability coefficient of .70 or higher is considered acceptable reliability
- gives the same results, every time Outliers - correct answer- Problematic outliers - outliers that are not representative of the population Beneficial outliers - outliers that are representative of the population Multivariate - unusual combinations of scores on different variables Qualitative Research methods and data analysis - correct answer- Approaches often used: observation/audit, participant observation, document study, interviews, focus groups sample size generally small Cyclical and iterative process w/ many rounds reexamining data repeatedly extremely useful to achieve deep understanding of how people think about specific topics
- Data reduction
- Data display (diagram, chart, matrix or text)
- Conclusion Drawing and Verification Modes of measurement - correct answer- Mean- Average of numbers Median- Middle number Mode- Number that occurs most often in a set Range- lowest - highest Standard Deviation- how spread out the numbers are Measurement tool: an item analysis for establishing reliability and validity Inferential Statistics - correct answer- Examples: t-test-analysis of two populations means through the use of statistical examination analysis of variance (ANOVA)-collection of statistical models and their associated procedures (such as "variation" among and between groups) *determine if there was a statistically significant difference between groups analysis of covariance (ANCOVA)- allows to compare one variable in 2 or more groups taking into account (or to correct for) variability of other variables; The ANCOVA is most useful in that it (1) explains an ANOVA's within-group variance, and (2) controls confounding factors. regression analysis- used to understand which among the independent variables are related to the dependent variable, and to explore the forms of these relationships.
- Issues identification
- Analysis
- Assessment of strengths and weaknesses
- Estimation of the parties' positions
- Consideration of outcomes that present wins for both/all parties Negotiation:
- Setting the opening position
- Setting the bottom line
- Selection of strategies
- Concession consideration
- Agenda determination
- Timing analysis
- Selection of communication modes Informal Consulting - correct answer- Does not require a written agreement or formal contract. Consists of acting as a resource person responsible for organizing health education materials and responding to requests for health education information/literature/materials Formal Consulting - correct answer- Requires a contract/written agreement between 2 parties. Hired for their expertise in a particular area for which the client needs assistance, advice, direction, etc. Which question would be the most appropriate for the HES to ask in the formative evaluation level of a consulting relationship? "What progress had been made to date?" National Center for Health Statistics (NCHS) - correct answer- quality data about the people and economy in the US. Results from the population and housing census, economic census, American community survey, and economic indicators. Rich source of info about the health status of the population and monitors trends in health status and health care delivery Training Needs Assessment - correct answer- 1. Identify the need or problem
- Determine the needs assessment design
- Collect data
- Analyze data
- Provide feedback Conduct 3-4 weeks ahead of time Questions to consider: trainings offered in the past, what skills/needs/behaviors need to be addressed from their perception, how would you like to receive the training, etc. Effective training programs - correct answer- 1. Determine training needs
- Set objectives
- Determine subject content to accomplish the objectives
- Select participants
- Determine the best schedule
- Select appropriate facilities
- Select appropriate instructors
- Select and prepare audiovisual aids
- Coordinate the program
- Evaluate the program Evaluations - correct answer- Formative: involves evaluation activities to generate info that will guide improvements for a program or health promotion efforts. May help to get rapid reactions/input to make midcourse corrections/changes Summative: includes activities taken to create a judgment on program's performance and whether specific goals and objectives were met Will focus on assessing if the training goals and specific objectives were obtained Levels of Training - correct answer- Level 1 - Reaction (surveys, feedback forms) Level 2 - Learning (survey before and after intervention) Level 3 - Behavior (interviews, observations) Level 4 - Results (archival review of documents for the indicators of success Crude death rate - correct answer- the total number of deaths to residents in a specified geographic area (country, state, county, etc.) divided by the total population for the same geographic area (for a specified time period, usually a calendar year) and multiplied by 100, Studies - correct answer- Randomized - the participants are divided by chance into separate groups that compare different treatments or other interventions Descriptive- observational studies which describe the patterns of disease occurrence in relation to variables such as person, place and time. Case/control - study that compares patients who have a disease or outcome of interest (cases) with patients who do not have the disease or outcome (controls) Probability- the measure of the likelihood that an event will occur Precaution Adoption Process Model - correct answer- seeks to identify all the stages involved when people commence health-protective behaviors and to determine the factors that lead people to move from one stage to the next. *Intrapersonal level example: When applying the ecological perspective to behavior change, the HES bases his/her smoking cessation intervention on the Precaution Adoption Process Model.
