Incorporating advocacy training in professional preparation programs.
Abstract: Advocacy for health and health education is both a professional and an ethical responsibility of health educators. Therefore, advocacy-related training must be integrated into the curricula of undergraduate and graduate health education programs. The purpose of this article is to provide rationale, strategies, and resources for incorporating advocacy training in undergraduate and graduate health education professional preparation programs. This articulation of rationale, strategies, and resources for integrating advocacy training in undergraduate and graduate health education curricula will support faculty in institutions of higher education in planning, implementing, assessing, and evaluating competency-based professional preparation experiences related to health advocacy.
Subject: Universities and colleges
College teachers
Public health
Ethics
Authors: Tappe, Marlene K.
Galer-Unti, Regina A.
Radius, Susan M.
Pub Date: 01/01/2009
Publication: Name: American Journal of Health Studies Publisher: American Journal of Health Studies Audience: Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 American Journal of Health Studies ISSN: 1090-0500
Issue: Date: Wntr, 2009 Source Volume: 24 Source Issue: 1
Product: Product Code: 8220000 Colleges & Universities; 8000120 Public Health Care; 9005200 Health Programs-Total Govt; 9105200 Health Programs NAICS Code: 61131 Colleges, Universities, and Professional Schools; 62 Health Care and Social Assistance; 923 Administration of Human Resource Programs; 92312 Administration of Public Health Programs SIC Code: 8221 Colleges and universities
Accession Number: 308743754
Full Text: Health educators have a professional and an ethical responsibility to advocate for health and health education (Galer-Unti & Tappe, 2006; Galer-Unti, Tappe, & Lachenmayr, 2004; Radius, Galer-Unti, & Tappe, 2009; Tappe & Galer-Unti, 2001). The professional responsibilities, competencies, and subcompetencies of health educators related to health advocacy are delineated in A Competency-Based Framework for Health Educators-2006 (National Commission for Health Education Credentialing, Inc. [NCHEC], Society for Public Health Education [SOPHE], & American Association for Health Education [AAHE], 2006). Additionally, the ethical responsibility of health educators to advocate for health and health education is identified in the profession's code of ethics (National Task Force on Ethics in Health Education [NTFEHE], 2000). To train more competent health educators it is essential for health education programs in institutions of higher education to integrate advocacy-related curricula and instruction into undergraduate and graduate health education professional preparation programs. However, health education faculty need guidance to integrate advocacy-related content and skills into undergraduate and graduate curricula (Radius et al.; Tappe, Galer-Unti, & Radius, 2007).

The purpose of this article is to provide rationale, strategies, and resources for incorporating advocacy training in undergraduate and graduate health education professional preparation programs. The articulation provided herein will support faculty in institutions of higher education in planning, implementing, assessing, and evaluating competency-based professional preparation experiences related to health advocacy. This article provides justification for advocacy-related instruction within undergraduate and graduate health education and identifies advocacy-related competencies and subcompetencies in A Competency-Based Framework for Health Educators-2006 (NCHEC et al., 2006). The article also provides a thorough identification of strategies for integrating competency-based advocacy-related instruction into undergraduate and graduate health education curriculum, instruction, and assessment. The article concludes by identifying resources for teaching advocacy for health and health education in undergraduate and graduate health education curricula.

ADVOCACY TRAINING IN HEALTH EDUCATION PROFESSIONAL PREPARATION

The literature related to advocacy training in health education professional preparation programs includes identification of health education faculty members' advocacy-related perceptions and their participation in advocacy activities (Tappe et al., 2007), an assessment of students' needs related to advocacy training (Cooper, 1986), the needs and capacity of faculty members (Radius et al., 2009) and higher education program administrators (Goodhart, 2002) to provide professional preparation and development related to advocacy, and strategies for integrating advocacy-related instruction into professional preparation and development experiences for health educators (Birch, 1991; Caira et al., 2003; Galer-Unti & Tappe, 2006; Freudenberg, 1982, 1984; Freudenberg & Kotelchuck, 2001; Goodhart; Ogden, 1986; Tappe & Galer-Unti, 2001). Tappe and associates found significant positive relationships between health education faculty members' perceptions of the importance of advocacy and their competence to teach advocacy, their own professional preparation in advocacy, their advocacy-related teaching experiences, and their participation in advocacy activities at the local, state, and national levels. These findings by Tappe and colleagues are consistent with previous findings that positive attitudes toward political involvement by health education students (Cooper) and public policy efficacy expectations of health educators (Holtrop, Price, & Boardley, 2000) were significantly associated with involvement in advocacy-related activities. Cooper reported that undergraduate health education students need basic instruction to help them develop knowledge, skills, and positive perceptions for participating in health and health education advocacy initiatives. Radius and associates found that many health education faculty reported that they are limited in their professional preparation and development to participate in advocacy and do not feel competent to teach advocacy for health and health education. Goodhart identified barriers to offering advocacy coursework including meeting the instructional demands of existing curricula, the number of courses already required in the program and the need to compete with other programs which require fewer credits for completion, lack of administrative interest or support, and a dearth of instructional resources related to advocacy.

Fortunately, authors (Birch, 1991; Caira et al, 2003; Freudenberg, 1982, 1984; Freudenberg & Kotelchuck, 2001; Galer-Unti & Tappe, 2006; Goodhart, 2002; Tappe & Galer-Unti, 2001) have provided guidance regarding the content of, and strategies for, advocacy-related professional preparation and development experiences for health educators. These strategies are incorporated into the following recommendations for integrating advocacyrelated instruction into curricula for undergraduate and graduate health education students based on the advocacy-related competencies and subcompetencies in A Competency-Based Framework for Health Educators-2006 (NCHEC et al., 2006).

RATIONALE FOR ADVOCACY-RELATED TRAINING IN PROFESSIONAL PREPARATION

Rationale for advocacy-related training in health education professional preparation is grounded in both A Competency-Based Framework for Health Educators-2006 (NCHEC et al., 2006) and the Code of Ethics for the Health Education Profession (NTFEHE, 2000). The responsibility for advocacy is integrated into "Area VII: Communicate and Advocate for Health and Health Education" in A Competency-Based Framework for Health Educators-2006 (NCHEC et al., 2006, p. 38). This responsibility area includes four competencies (see Table 1) and 22 subcompetencies spread across three levels of education and experience in health education.

Health educators have ethical responsibilities to the public and the profession to advocate for health and health education (see NTFEHE, 2000). Health educators' advocacy-related responsibilities to the public include encouraging "...actions and social policies that support and facilitate the best balance of benefits over harm for all affected parties" (NTFEHE, Article I, Section 2, p. 216) and acting "... on issues that can adversely affect the health of individuals, families, and communities" (NTFEHE, Article I, Section 4, p. 214). Health educators' advocacy-related responsibilities to the profession include "... involvement in issues related to the health of the public" (NTFEHE, Article II, Section 1, p. 214). Given the profession and ethical responsibilities of health educators related to health advocacy, the following sections provide guidance for integrating advocacy instruction into undergraduate and graduate health education curricula.

ADVOCACY-RELATED CURRICULA, INSTRUCTION, AND ASSESSMENT IN PROFESSIONAL PREPARATION

Advocacy-related curricula, instruction, and assessment in health education professional preparation should provide undergraduate and graduate students with the knowledge, skills, and training they to need to actively plan, implement, and evaluate advocacy initiatives. Guiding premises, approaches, content, and competency-based learning and assessment activities for advocacy-related curricula, instruction, and assessment in institutions of higher education are delineated in the following sections of this article.

GUIDING PREMISES FOR ADVOCACY-RELATED CURRICULA, INSTRUCTION, AND ASSESSMENT

The development of advocacy-related curricula, instruction, and assessment for undergraduate and graduate health education students can be guided by a number of premises. The most fundamental premise is that advocacy-related curricula, instruction, and assessment should be based on the competencies and subcompetencies delineated in A Competency-Based Framework for Health Educators-2006 (NCHEC et al., 2006) and that there is alignment between advocacy-related subcompetencies, curricula, instruction, and assessment. Additional premises for advocacy-related curricula, instruction, and assessment initiatives are that these initiatives should be multifaceted (Tappe & Galer-Unti, 2001), include both formal and informal learning experiences (Tappe & Galer-Unti), and provide students with hands-on and authentic opportunities to apply and practice their advocacy-related knowledge and skills (Radius et al., 2009). Advocacy-related curricula, instruction, and assessment should provide students with multiple opportunities to develop, apply, and receive feedback regarding their advocacy-related knowledge and skills (Tappe & Galer-Unti). Finally, in addition to building students' advocacy-related knowledge and skills, health education faculty should build students' perceptions regarding the importance of advocacy initiatives and actively encourage students to engage in advocacy activities (Radius et al.).

APPROACHES TO ADVOCACYRELATED CURRICULA, INSTRUCTION, AND ASSESSMENT

As noted previously, students should be provided with both formal and informal learning experiences related to advocacy. Formal learning experiences include undergraduate and graduate advocacy courses focused on advocacy or advocacy-related concepts and skills infused into courses designed to meet multiple responsibilities and competencies of health educators (Goodhart, 2002; Tappe & Galer-Unti, 2001). One approach is to use a writing intensive course to focus on responsibility Area VII: Communicate and Advocate for Health and Health Education (see Galer-Unti & Tappe, 2006). Advocacy can also be integrated into service learning (Tappe & Galer-Unti) and internships (Freudenberg, 1982, 1984; Goodhart; Tappe & Galer-Unti) for undergraduate and graduate students. Formal instruction related to advocacy can take the form of independent study learning experiences (Freudenberg, 1984) and applied research projects (Goodhart). Informal advocacy-related learning experiences include mentoring by faculty (Goodhart) and students' participation in student organizations focused on health-related (e.g., the BACCHUS Network) or social issues (e.g., Student World Assembly), professional honoraries (i.e., Eta Sigma Gamma), and state (e.g., Maine Association for Health, Physical Education, Recreation, and Dance) and national organizations (e.g., Society for Public Health Education) for health education professionals (Tappe & Galer-Unti).

CONTENT FOR ADVOCACY INSTRUCTION

Authors have identified instructional content related to advocacy (Caira et al., 2003; Freudenberg, 1982, 1984; Galer-Unti, n.d.; Galer-Unti & Tappe, 2006; Galer-Unti et al., 2004; Tappe & Galer-Unti, 2001). This proposed content includes, but is not limited to, the following: advocacy terminology (see Galer-Unti, n.d.; Galer-Unti et al.); advocacy in relationship to the Code of Ethics for the Health Education Profession (NTFEHE, 2000) and A Competency-Based Framework for Health Educators-2006 (NCHEC et al., 2006) (Tappe & Galer-Unti); health educators' roles related to engaging in advocacy (Caira et al.; Tappe & Galer-Unti) and teaching advocacy-related knowledge and skills to enable others to advocate for personal, family, and community health (Tappe & Galer-Unti); identifying and demystifying common concerns related to participating in advocacy activities (Caira et al.; see Galer-Unti et al.); fundamentals of civics (Caira et al; see Galer-Unti, n.d.); public health law (Caira et al.); the process of policy development and implementation (Freudenberg, 1984; Galer-Unti, n.d.; Goodhart; Radius et al., 2009; Tappe & Galer-Unti); the roles of nongovernmental organizations and lobbyists in the policy development process (Tappe & Galer-Unti); identifying sources of power and influence (Caira et al.; Goodhart); identifying and accessing local, state, and national policymakers (Goodhart; Tappe & Galer-Unti); policymakers' views, responsibilities, and needs (Caira et al.; Galer-Unti & Tappe, 2006); voter registration and voting behavior (Tappe & Galer-Unti); identifying public policy issues (Caira et al.); examining both sides of policy-related issues (Galer-Unti & Tappe); advocacy strategies and guidelines for the effective use of these strategies (Caira et al.; Freudenberg, 1984; Galer-Unti et al.; Tappe & Galer-Unti); advocacy principles (see Caira et al., 2003; Goodhart); social epidemiology (Freudenberg, 1982, 1984); the framing of policy issues (Caira et al.); strategies for corresponding, meeting, and establishing relationships with policymakers (Caira et al.; Goodhart); gauging (Goodhart) and influencing (Galer-Unti & Tappe) public opinion; media advocacy and developing relationships with the media (Caira et al; Galer-Unti & Tappe; Goodhart); community organization and coalition development (Caira et al; Freudenberg, 1982; Goodhart; Tappe & Galer-Unti); and resources for advocacy initiatives (Caira et al.; see Galer-Unti et al.)

STRATEGIES FOR TEACHING AND ASSESSING ADVOCACY-RELATED SUBCOMPETENCIES

A variety of authors have also identified diverse strategies for teaching and assessing advocacy-related subcompetencies (Birch, 1991; Caira et al., 2003; Freudenberg, 1982, 1984; Freudenberg & Kotelchuck, 2001; Galer-Unti n.d.; Galer-Unti & Tappe, 2006; Galer-Unti et al., 2004; Ogden, 1986; Tappe & Galer-Unti, 2001). Often the approaches used to provide instruction related to advocacy involve the creation of an array of materials used to advocate for health and health education. The creation of these materials often involves formal writing assignments and may include, but is not limited to, the following advocacy-related materials: public service announcements (PSAs) (Galer-Unti & Tappe; Tappe & Galer-Unti); paid advertisements (Galer-Unti & Tappe); letters to the editor (Birch; Galer-Unti & Tappe; Galer-Unti et al.; Goodhart; Tappe & Galer-Unti); opinion (op-ed) or guest editorials (Galer-Unti & Tappe; Galer-Unti et al.; Goodhart); correspondence with policymakers (Galer-Unti & Tappe; Goodhart; Tappe & Galer-Unti); position papers (Birch; Galer-Unti & Tappe; Tappe & Galer-Unti); rationale statements (Galer-Unti & Tappe); fact sheets (Goodhart); talking points (Galer-Unti & Tappe); issue briefs (Galer-Unti & Tappe); news releases (Galer-Unti & Tappe; Galer-Unti et al.); written testimony or scripts for oral testimony (Galer-Unti & Tappe; Galer-Unti et al.); PowerPoint[TM] presentations (Tappe & Galer-Unti); scripts for videos; websites (Tappe & Galer-Unti); and draft laws (Ogden). Classroom-based instructional strategies may involve games (e.g., Advocacy Jeopardy; see Galer-Unti, n.d.), presentations by guest speakers (Caira et al.; Goodhart), discussions, and case studies (Goodhart) related to health issues and advocacy-related concepts and strategies. Classroom-based instructional activities may also involve

debates (Galer-Unti & Tappe) and simulated media interviews (see Birch), community forums (Birch; Galer-Unti & Tappe), city council or school board meetings (Galer-Unti & Tappe), meetings with legislators or legislative assistants (Birch), and legislative hearings (Galer-Unti & Tappe). Authentic learning experiences related to advocacy may include, but are not limited to, the following field-based learning activities: writing a letter to an editor (Goodhart); responding to advocacy alerts (Goodhart); observing or participating in school board or city council meetings (Galer-Unti & Tappe; Goodhart); interviewing health educators, policymakers, and lobbyists; observing a legislative session (Goodhart); developing issue-specific advocacy strategies (Caira); corresponding with policymakers; meetings with policymakers or their legislative assistants (Birch; Goodhart); analyzing public opinion polls (Galer-Unti & Tappe); and policy analysis (Freudenberg, 1984; Freudenberg & Kotelchuck; Galer-Unti & Tappe). Participation in these activities may lead to an array of informal and formal writing assignments. Informal assignments aligned with these activities may include individual or cooperative note taking, journal entries, double-entry journals, lecture summaries, and free writes (Galer-Unti & Tappe). Formal writing assignments aligned with these activities may include the creation of aforementioned advocacy materials or include annotated bibliographies and literature reviews of articles regarding advocacy issues, strategies, and initiatives. Formal writing assignments may include content analyses of health-related newspaper articles, advocacy materials, and health- and education-related legislation. Students can also complete technology-based assignments including the creation of PowerPoint[TM] presentations, videos, websites, and blogs as well as the use of Twitter.

Specific examples of instructional strategies and assessments aligned with health education competencies and subcompetencies for "Area VII: Communicate and Advocate for Health and Health Education" (NCHEC et al., 2006, p. 38) are delineated in Tables 2 through 4. Distinct examples of instructional strategies and assessments aligned with the "Entry" and "Advanced 1" subcompetencies (NCHEC et al., p. 38) are identified in Tables 2 and 3, respectively. The "Entry" subcompetencies are for health educators with a baccalaureate or master's degree and less than five years of experience whereas the "Advanced 1" subcompetencies are for health educators with a baccalaureate or master's degree and five or more years of experience (NCHEC et al., p. 38). Examples of instructional strategies aligned with the "Advanced 2" subcompetencies (NCHEC et al., p. 38) are identified in Table 4. "Advanced 2" subcompetencies (NCHEC et al., p. 38) are for health educators with a doctorate and five or more years of experience.

RESOURCES FOR ADVOCACY INSTRUCTION AND ASSESSMENT

There is a wide range of resources for providing instruction related to advocacy. As noted earlier, various authors (Birch, 1991; Caira et al., 2003; Freudenberg, 1982, 1984; Freudenberg & Kotelchuck, 2001; Galer-Unti n.d.; Galer-Unti & Tappe, 2006; Galer-Unti et al., 2004; Ogden, 1986; Tappe & Galer-Unti, 2001) have identified an array of strategies for teaching and assessing advocacy-related subcompetencies. There are organizations, agencies, and other groups that have websites related to advocacy. Examples of these resources include legislative materials from the American Public Health Association (www.apha.org/advocacy/activities/), ideas for media advocacy from the Centers for Disease Control and Prevention (http://www.cdc. gov/dhdsp/cdcynergy_training/Content/activeinformation/resources/Media_Advocacy_Tips.pdf), websites related to advocacy from the Coalition of National Health Education Organizations (http:// www.health.educationadvocate. org/resources/websites.html), and "how to" information for advocacy work from Research America (www.researchamerica.org/advocacy_resources) and the University of Kansas (http://ctb.ku.edu/en/).

CONCLUSION

Faculty in institutions of higher education should recognize not only the importance and the need for advocacy training in future professionals, but also recognize that the provision of knowledge and skills to advocate for health and health education are professional mandates. The rationale, strategies, and resources for incorporating competency-based advocacy training in undergraduate and graduate health education professional preparation programs described in this article are useful for faculty who are seeking to initiate or become more effective in facilitating students' development of advocacy-related knowledge and skills. Enabling students to develop knowledge and skills to advocate for health and health education is critical to promoting health and ensuring the continued viability of the profession and practice of health education.

REFERENCES

Birch, D. A. (1991). Helping prospective school health educators develop political advocacy skills. Journal of School Health, 61, 176-177.

Caira, N. M., Lachenmayr, S., Sheinfeld, J., Goodhart, F. W., Cancialosi, L., & Lewis, C. (2003). The health educator's role in advocacy and policy: Principles, processes, programs, and partnerships. Health Promotion Practice, 4, 303-313.

Cooper, C. E. (1986). Political knowledge and participation of health education students. Health Education, 17(5), 10-13.

Freudenberg, N. (1982). Health education for social change: A strategy for public health in the US. International Journal of Health Education, 24, 138-145.

Freudenberg, N. (1984). Training health educators for social change. International Quarterly of Community Health Education, 5, 37-52.

Freudenberg, N., & Kotelchuck, D. (2001). Political competencies and public health leadership. American Journal of Public Health, 91, 468.

Galer-Unti, R. A. (n.d.). Advocacy jeopardy. Retrieved March 12, 2009 from http://www.ncpe4me.com/ powerpoint/advocacy_jeopardy.ppt

Galer-Unti, R. A., & Tappe, M. K. (2006). Developing effective written communication and advocacy skills in entry-level health educators through writing intensive program planning methods courses. Health Promotion Practice, 7, 110-116.

Galer-Unti, R. A., Tappe, M. K., & Lachenmayr, S. (2004). Advocacy 101: Getting started in health education advocacy. Health Promotion Practice, 5, 280-288.

Goodhart, F. W. (2002). Teaching advocacy to public health students: The New Jersey experience. Health Promotion Practice, 3, 341-346.

Holtrop, J. S., Price, J. H., & Boardley, D. J. (2000). Public policy involvement by health educators. American Journal of Health Behavior, 24, 132-142.

National Commission for Health Education Credentialing, Inc., Society for Public Health Education, & American Association for Health Education. (2006). A competency-basedframework for health educators-2006. Whitehall, PA: The National Commission for Health Education Credentialing, Inc.

National Task Force on Ethics in Health Education. (2000). Code of ethics for the health education profession. Journal of Health Education, 31, 216-217.

Ogden, H. G. (1986). The politics of health education: Do we constrain ourselves? Health Education Quarterly, 13, 1-7.

Radius, S. M., Galer-Unti, R. A., & Tappe, M. K. (2009). Educating for advocacy: Recommendations for professional preparation and development based on a needs and capacity assessment of health education faculty. Health Promotion Practice, 10, 83-91.

Tappe, M. K., & Galer-Unti, R. A. (2001). Health educators' role in promoting health literacy and advocacy for the 21st century. Journal of School Health, 71, 477-482.

Tappe, M. K., Galer-Unti, R. A., & Radius, S. M. (2007). Health education faculty's advocacy-related perceptions and participation. American Journal of Health Studies, 22, 186-195.

Marlene K. Tappe, PhD, CHES, is affiliated with Department of Health Science, Minnesota State University-Mankato. Regina A. Galer-Unti, PhD, CHES, is affiliated with Public Health Faculty, Walden University. Susan M. Radius, PhD, CHES, is affiliated with Health Science Department, Towson University. Please address all correspondence to Marlene K. Tappe, PhD, CHES, Department of Health Science, 213 Highland Center North, Minnesota State University-Mankato, Mankato, MN 56001. PHONE: 507-389-2686, FAX: 507-389-2985, E-mail: marlene.tappe@mnsu.edu.
Table 1. Number of Subcompetencies Related to Responsibility Area IV:
Communicate and Advocate for Health and Health Education by Level

                              Number of Subcompetencies by Level

Competency *                 Entry-Level   Advanced 1   Advanced 2

A. Analyze and respond            1            3            2
to current and future
needs in health education.
B. Apply a variety of             7            0            0
communication methods
and techniques.
C. Promote the health             1            0            4
education profession
both individually
and collectively.
D. Influence health               1            1            2
policy to promote health.

* NCHEC et al., 2006, p. 38

Table 2. Strategies for Teaching and Assessing Entry-Level
Advocacy-Related Subcompetencies

Competency *        Subcompetency *     Learning Activity

A. Analyze and      1. Analyze          Brainstorming
respond to          factors (e.g.,      of factors
current and         social, cultural,   that influence
future needs in     demographic,        decision makers.
health education.   political)
                    that influence      Review of
                    decision makers.    advocacy
                                        materials and
                                        strategies
                                        designed to
                                        influence
                                        decision makers.
                                        Attendance at,
                                        or observation
                                        of, city council
                                        or school board
                                        meetings to
                                        identify influences
                                        on decision makers.

                                        Guest lecture by
                                        a policymaker
                                        which addresses
                                        factors that
                                        influence
                                        decision makers.

                                        Interview with
                                        a policymaker
                                        regarding
                                        influences on his/
                                        her decisions.

B. Apply a          1. Assess the       Analysis of
variety of          appropriateness     advocacy materials
communication       of language in      to assess the
methods and         health education    appropriateness
techniques.         messages.           of the language
                                        of the advocacy
                                        message.

                    3. Respond to       Development of
                    public input        materials to
                    regarding health    respond to public
                    education           input regarding
                    information.        health education
                                        information.

                    2. Compare          Reading of
                    different           articles or
                    methods of          documents
                    distributing        regarding
                    educational         advocacy
                    materials.          audiences and
                                        communication
                    4. Use              methods and
                    culturally          techniques for
                    sensitive           advocacy.
                    communication
                    methods and         Brainstorming
                    techniques.         of advocacy
                                        audiences and
                    5. Use              communication
                    appropriate         methods
                    techniques for      techniques for
                    communicating       advocacy.
                    health education
                    information.        Attendance at,
                                        or observation
                    6. Use oral,        of, city council
                    electronic,         or school board
                    and written         meetings to
                    techniques for      identify
                    communicating       communication
                    health education    methods and
                    information.        techniques for
                                        advocacy.
                    7. Demonstrate
                    proficiency in      Interviews with
                    communicating       policymakers
                    health              regarding
                    information and     communication
                    health education    methods and
                    needs.              techniques for
                                        advocacy.

                                        Development of
                                        materials to use
                                        in debates and
                                        mock briefings,
                                        community forums,
                                        legislative
                                        hearings, city
                                        council and
                                        school board
                                        meetings.

                                        Development
                                        of advocacy
                                        materials.

C. Promote the      1. Develop a        Brainstorming
health education    personal plan       of strategies
profession both     for professional    for professional
individually and    development.        growth including
collectively.                           professional
                                        development for,
                                        and involvement
                                        in, advocacy
                                        activities.

D. Influence        1. Identify the     Reading of
health policy to    significance and    articles or
promote health.     implications of     documents
                    health care         regarding the
                    providers'          significance
                    messages to         and implications
                    consumers.          of health care
                                        providers'
                                        messages to
                                        consumers.

                                        Discussion
                                        related to the
                                        significance
                                        and implications
                                        of health care
                                        providers'
                                        messages to
                                        consumers.

Competency *        Subcompetency *     Assessment

A. Analyze and      1. Analyze          Journal entry
respond to          factors (e.g.,      or minute paper
current and         social, cultural,   related to the
future needs in     demographic,        brainstorming
health education.   political)          activity.
                    that influence      Journal entry
                    decision makers.    or minute paper.

                                        Meeting notes,
                                        journal entry,
                                        and/ or essay
                                        regarding
                                        attendance at,
                                        or observation
                                        of, a city
                                        council or
                                        school board
                                        meeting.
                                        Lecture notes,
                                        minute paper,
                                        journal entry,
                                        or double-entry
                                        journal related
                                        to the guest
                                        lecture.
                                        Interview
                                        questions and
                                        notes, journal
                                        entry, or
                                        minute paper
                                        related to the
                                        interview.
B. Apply a          1. Assess the       Journal entry,
variety of          appropriateness     double-entry
communication       of language in      journal, or
methods and         health education    minute paper
techniques.         messages.           related to the
                                        analysis of
                                        the advocacy
                                        materials.
                    3. Respond to       Briefing notes,
                    public input        issue briefs,
                    regarding health    talking points,
                    education           scripts for
                    information.        oral testimony,
                                        written
                                        testimony,
                                        PowerPoints[TM],
                                        and videos.
                    2. Compare          Journal entry,
                    different           double-entry
                    methods of          journal,
                    distributing        abstract, or
                    educational         essay related
                    materials.          to the advocacy
                                        articles or
                    4. Use              documents.
                    culturally
                    sensitive
                    communication
                    methods and         Journal entry
                    techniques.         or minute paper
                                        related to the
                    5. Use              brainstorming
                    appropriate         activity.
                    techniques for
                    communicating
                    health education
                    information.        Meeting notes,
                                        journal entry,
                    6. Use oral,        and/or essay
                    electronic,         related to the
                    and written         attendance at,
                    techniques for      or observation
                    communicating       of, a city
                    health education    council or
                    information.        school board
                                        meeting.
                    7. Demonstrate
                    proficiency in      Interview
                    communicating       questions and
                    health              notes, journal
                    information and     entry, and/or
                    health education    essay related to
                    needs.              the interview.

                                        Briefing notes,
                                        issue briefs,
                                        talking points,
                                        scripts for
                                        oral testimony,
                                        written
                                        testimony,
                                        PowerPoints[TM],
                                        and videos.

                                        Letters to the
                                        editor, op-eds,
                                        letters to
                                        policymakers,
                                        PSAs, paid
                                        advertising,
                                        PowerPoints[TM],
                                        videos,
                                        websites, blogs,
                                        podcasts, and
                                        Twitters.
C. Promote the      1. Develop a        Journal entry
health education    personal plan       or minute paper
profession both     for professional    related to the
individually and    development.        brainstorming
collectively.                           activity.

                                        Professional
                                        development plan
                                        which includes
                                        professional
                                        development for,
                                        and involvement
                                        in advocacy
                                        activities.
D. Influence        1. Identify the     Journal entry,
health policy to    significance and    double-entry
promote health.     implications of     journal,
                    health care         abstract, or
                    providers'          essay related
                    messages to         to the articles
                    consumers.          or documents.

                                        Journal entry
                                        or minute paper
                                        related to the
                                        discussion
                                        activity.

* NCHEC et al., 2006, p. 38

Table 3. Strategies for Teaching and Assessing Advanced 1
Advocacy-Related Subcompetencies

Competency *   Subcompetency *   Learning          Assessment
                                 Activity

A. Analyze     1. Respond to     Reading of        Double-entry
  and respond  challenges        articles or       journal,
  to current   facing health     documents         essay,
  and future   education         regarding         abstract,
  needs in     programs.         challenges        annotated
  health                         facing health     bibliography,
  education.                     education         or review of
                                 programs.         literature
                                                   related to
                                                   the articles
                                                   or documents.

                                 Discussion        Minute paper
                                 and/or            related to
                                 writing           the
                                 activity to       discussion;
                                 identify          writing
                                 advocacy          activity
                                 strategies to     regarding
                                 respond to        advocacy
                                 challenges        strategies to
                                 facing health     respond to
                                 education         challenges
                                 programs.         facing health
                                                   education
                                                   programs.

                                 Interviews        Interview
                                 with health       questions and
                                 education         notes or tapes
                                 professionals     and essay
                                 to identify       related to
                                 advocacy          the interview.
                                 strategies to
                                 respond to
                                 challenges
                                 facing health
                                 education
                                 programs.
               2. Implement      Reading of        Double-entry
               strategies        articles or       journal,
               for advocacy      documents         essay,
               initiatives.      regarding         abstract,
                                 strategies        annotated
                                 for advocacy      bibliography,
                                 initiatives.      or review of
                                                   literature
                                                   related to
                                                   advocacy
                                                   articles or
                                                   documents.
                                 Brainstorming     Minute paper
                                 of strategies     related to
                                 for advocacy      brainstorming
                                 initiatives.      activity.

                                 Development of    Briefing notes,
                                 materials to      issue briefs,
                                 use in debates    talking
                                 and mock          points,
                                 briefings,        scripts for
                                 community         oral testimony,
                                 forums,           written
                                 legislative       testimony,
                                 hearings, city    PowerPoints
                                 council and       [TM], and
                                 school board      videos.
                                 meetings.

                                 Development       Letters to the
                                 and use of        editor, op-eds,
                                 materials for     letters to
                                 advocacy          policymakers,
                                 initiatives.      PSAs, paid
                                                   advertising,
                                                   PowerPoints [TM],
                                                   videos,
                                                   websites, blogs,
                                                   podcasts, and
                                                   Twitters.
               3. Use            Review of         Double-entry
               evaluation        advocacy          journal, essay,
               data to           materials to      abstract,
               advocate          examine the use   annotated
               for health        of evaluation     bibliography
               education.        data to           related to the
                                 advocate for      use of
                                 health            evaluation data
                                 education         in advocacy
                                                   materials.
                                 Use evaluation    Model policy.
                                 data to develop
                                 a model policy
                                 related to
                                 health
                                 education.
                                 Use of            Briefing notes,
                                 evaluation data   issue briefs,
                                 to develop        talking points,
                                 advocacy          scripts for oral
                                 materials to      testimony,
                                 use in debates,   written testimony,
                                 briefings,        scripts for PSAs
                                 community         and paid
                                 forums,           advertising,
                                 legislative       letters to the
                                 hearings, city    editor, op-eds,
                                 council and       letters to
                                 school board      policymakers,
                                 meetings.         model policies,
                                                   Power Points [TM],
                                                   videos, websites,
                                                   webcasts, blogs,
                                                   and Twitters.

D. Influence   1. Use            Review of         Double-entry
  health       research          advocacy          journal, essay,
  policy to    results to        materials to      related to the
  promote      develop           examine the use   use of research
  health.      health            of research       data to develop
               policy.           data in these     health policy.
                                 initiatives.      Interview
                                 Interviews with   questions and
                                 policymakers      notes or tapes
                                 regarding the     and essay related
                                 use of research   to the interview.
                                 data in
                                 developing
                                 health policy.
                                 Use of research   Model policy.
                                 data to develop
                                 a model health
                                 policy.
                                 Use of research   Briefing notes,
                                 data to develop   issue briefs,
                                 advocacy          talking points,
                                 materials to      scripts for oral
                                 influence the     testimony, written
                                 development of    testimony, scripts
                                 health policy.    for PSAs and paid
                                                   advertising,
                                                   letters to the
                                                   editor, op-eds,
                                                   letters to
                                                   policymakers,
                                                   model policies,
                                                   PowerPoints[TM],
                                                   videos, websites,
                                                   webcasts, blogs,
                                                   and Twitters.

Table 4. Strategies for Teaching and Assessing Advanced 2
Advocacy-Related Subcompletencies

Competency *           Subcompetency *       Learning Activity

A. Analyze and       1. Analyze the         Reading, writing,
respond to           interrelationships     and discussion
current and          among ethics,          activities
future needs         values, and            regarding
in health            behavior.              advocacy-related
education.                                  ethical
                                            responsibilities
                                            and behaviors
                                            of health educators.
                     2. Relate health       Reading, writing,
                     education issues       discussion
                     to larger social       activities
                     issues.                regarding the
                                            relationship
                                            between health
                                            education issues and
                                            social issues.
                                            Interviews with
                                            health educators
                                            regarding the
                                            relationship
                                            between health
                                            education
                                            issues and
                                            social issues.
C. Promote the       1. Describe the        Review of literature
health education     state of the art       and internet
profession           of health education    materials to
both individually    practice.              describe the
and collectively.                           state of the art
                                            of health education
                                            practice related
                                            to advocacy.
                                            Interviews with
                                            health educators
                                            regarding the
                                            state of the
                                            art of health
                                            education practice
                                            related to advocacy
                     2. Explain major       Reading, writing,
                     responsibilities       and discussion
                     of the health          activities regarding
                     educator in the        the advocacy-related
                     practice of            responsibilities of
                     health education.      health educators.
                     3. Explain the         Review of literature
                     role of health         including internet
                     education              materials to examine
                     associations in        advocacy initiatives
                     advancing the          by health education
                     profession.            associations to
                                            advance the
                                            profession.
                                            Interviews with
                                            health educators
                                            regarding advocacy
                                            initiatives by
                                            health education
                                            associations to
                                            advance the profession.
                     4. Explain the         Review of literature
                     benefits of            and internet
                     participating          materials to identify
                     in professional        advocacy initiatives
                     organizations.         of professional
                                            organizations.
                                            Interviews with
                                            health educators
                                            regarding the
                                            advocacy initiatives
                                            of professional
                                            organizations.
D. Influence         1. Describe how        Interviews with
health policy        research results       policymakers
to promote           influence health       regarding the
health.              policy.                impact of data in
                     2. Use evaluation      health-related
                     findings in policy     decision making.
                     analysis and           Analysis of the
                     development.           use evaluation
                                            and research
                                            data in existing or
                                            proposed health
                                            policies.
                                            Use of evaluation
                                            and research
                                            data to develop
                                            a model policy
                                            related to
                                            health and health
                                            education.
                                            Use of evaluation
                                            research data to
                                            develop advocacy
                                            materials to use
                                            in debates,
                                            briefings,
                                            community forums,
                                            city council
                                            and school
                                            board meetings,
                                            and legislative
                                            hearings, to
                                            influence policy
                                            development.

Competency *           Subcompetency *        Assessment

A. Analyze and       1. Analyze the         Double-entry
respond to           interrelationships     journal, or essay
current and          among ethics,          regarding
future needs         values, and            advocacy-related
in health            behavior.              ethical responsibilities
education.                                  of health educators
                                            and behaviors.
                     2. Relate health       Double-entry
                     education issues       journal, or essay
                     to larger social       regarding the
                     issues.                relationship
                                            between health
                                            education issues
                                            and social
                                            issues
                                            Interview questions
                                            and notes or tapes
                                            and essay related to the
                                            interview.
C. Promote the       1. Describe the        Double-entry
health education     state of the art       journal, essay,
profession           of health education    abstract,
both individually    practice.              annotated bibliography
and collectively.                           related to
                                            advocacy
                                            initiatives by
                                            health education
                                            associations to
                                            advance the profession.
                                            Interview questions
                                            and notes or tapes
                                            and essay related
                                            to the interview.
                     2. Explain major       Journal entry,
                     responsibilities       double-entry
                     of the health          journal, or essay
                     educator in the        regarding the
                     practice of            advocacy-related
                     health education.      responsibilities
                                            of health educators
                     3. Explain the         Double-entry
                     role of health         journal, essay,
                     education              abstract,
                     associations in        annotated
                     advancing the          bibliography
                     profession.            related to
                                            advocacy
                                            initiatives by
                                            health education
                                            associations to
                                            advance the profession.
                                            Interview questions
                                            and notes or tapes
                                            and essay related
                                            to the interview.
                     4. Explain the         Double-entry
                     benefits of            journal or
                     participating          essay related
                     in professional        to the advocacy
                     organizations.         initiatives of
                                            professional
                                            organizations.
                                            Interview questions
                                            and notes or tapes
                                            and essay related
                                            to the interview.
D. Influence         1. Describe how        Interview questions
health policy        research results       and notes or tapes
to promote           influence health       and essay related
health.              policy.                to the interview.
                     2. Use evaluation      Double-entry
                     findings in policy     journal or essay
                     analysis and           related to the
                     development.           analysis of the use
                                            of evaluation
                                            and research data.
                                            Model policy
                                            related to the use
                                            of evaluation
                                            and research data
                                            to develop the
                                            model policy.
                                            Briefing notes,
                                            issue briefs,
                                            talking points,
                                            scripts for oral
                                            testimony, written
                                            testimony, scripts
                                            for PSAs and paid
                                            advertising,
                                            letters to the
                                            editor, op-eds,
                                            letters to policymakers,
                                            model policies,
                                            PowerPoints[TM],
                                            videos, websites,
                                            webcasts, blogs, and
                                            Twitters.
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