Core Competencies for Chronic Disease Prevention Practice

Mary Kane, MSLIS; Jennifer Royer-Barnett, MPA; Jeanne Alongi, DrPH


Prev Chronic Dis. 2019;16(10):e144 

In This Article

Development of Revised Competencies

Step 1: 2007 Core Competencies Review

The PDC found that the 2007 Competencies did not emphasize key public health and chronic disease prevention aspects including health equity, cultural competence, and quality improvement. The Committee also forecasted gaps related to system-level and policy-level concepts in chronic disease such as social determinants of health, health disparities, payer for health care services, and communities' relationship to chronic disease prevention and control.

Step 2: Environmental Scan and Alignment Review

Six documents describing frameworks that were particularly relevant to chronic disease prevention practice in state health departments were found in the environmental scan. The subsequent environmental scan results were consistent with prioritizing evidence-based decision-making regarding public health programming, administrative practices, and organizational capacity development:

  • Administrative evidence-based practices. This literature review proposed 5 priority administrative practice areas for fostering more effective public health. These were workforce development, leadership, organizational climate and culture, relationships and partnerships, and financial processes.[5]

  • Chronic disease domains. The National Center for Chronic Disease Prevention and Health Promotion of the Centers for Disease Control and Prevention (CDC) articulated a set of domains for chronic disease prevention practice around which state health departments can coordinate chronic disease prevention efforts across traditional categorical lines, thereby optimizing effectiveness and efficiency of public health practice. These domains are epidemiology and surveillance, environmental approaches, health care systems interventions, and community programs linked to clinical services.[6]

  • Core competencies for public health professionals. The Council on Linkages Between Academia and Public Health Practice identified a set of skills for general public health practice. This set is based on the 10 essential services and is broadly applicable to public health practice, education, and research.[7,8]

  • Model for chronic disease coordination. CDC's National Center for Chronic Disease Prevention and Health Promotion proposed a model for building capacity for chronic disease prevention practice in state health departments that was based on a review of experience implementing the federally funded Coordinated Chronic Disease Program. Proposed model elements included evidence-based interventions, consistent communications, strategic use of staff, strong infrastructure, focused agenda, identification of functions, comprehensive planning, management resources, relationship building, and collaborative leadership.[9]

  • Public Health Accreditation Board (PHAB) standards and measures. PHAB developed standards for voluntary health department accreditation with the objective of promoting high performance, continuous improvement, and accountability. The 12 evidence-based domains are assessment, investigation, education, community engagement, policies and plans, enforcement, access to care, workforce competency, quality improvement, evidence-based practices, administration and management, and governance.[10]

  • State Activation and Response (STAR). In response to requests from state chronic disease directors, NACDD developed an organizational capacity development model to assist states in strengthening their ability to successfully practice chronic disease prevention and health promotion. The STAR framework includes evidence-based public health practice, leadership, management and administration, organizational climate and culture, partnerships and relationships, and workforce development.[11]

Step 3: Stakeholder Input

With NACDD staff support, the PDC surveyed NACDD members who responded to an open invitation in July 2015, resulting in 74 responses. NACDD's diabetes council provided collective feedback. Respondents provided information on location, type of organization, and number of years in chronic disease practice. NACDD members from 37 states and 2 US territories responded to the survey; most were from state health departments (71%, n = 49). The rest of the respondents were from local health departments (13%, n = 9) or worked at other organizations or agencies (16%, n = 11) (5 respondents skipped the question).

The range of work experience in chronic disease prevention was 0–3 years or more than 10 years; of the 70 respondents (4 respondents skipped the question), 38 had 10 or fewer years of experience, and 32 had more than 10 years of experience. To explore any potential themes related to length of work experience, the PDC compared the responses of practitioners with more than 10 years of experience with those who had 10 years or fewer. When the samples were cross-referenced, responses were similar and allowed the PDC to generalize across all levels of experience.[4]

Survey findings, key informant interviews, and webinar polling confirmed the need for revision to the original competencies set and revamping the implementation and dissemination approach previously in place. Specifically, respondents cited the importance of competency areas such as health equity, health systems transformation, quality improvement, and design thinking, and they reflected on the priority of each competency area. As a result, the PDC reordered the subcompetencies under each competency area to begin with the highest priority and most essential items.[6] The proposed Competencies were used in the development of the May 2017 general member webinar, which introduced NACDD members to the new Competencies and described plans to apply the Competencies in both standard and new ways to better serve members. In 2016 and 2017, 289 NACDD members attended or viewed 3 general member webinars, which reviewed the updated Competencies. Input on implementation and dissemination showed opportunities for technology-based assessment tools and ongoing training support regarding tool use.

Step 4: Recommendations Development

As findings were collected in steps 1 through 3, they were synthesized by the PDC. Draft recommendations were circulated in several iterations and shared with key informants for confirmation until the Committee agreed they had reached consensus.

The resulting final recommendations expanded on the original 2007 Competencies framework. The report recommended that the competencies be relabeled "competency areas" rather than "domains" to avoid confusion referencing other related competency sets and to label the items themselves as "subcompetencies" rather than "competencies." No new competency areas were added, indicating the utility of the 2007 framework.[4]

Twenty-five new subcompetencies were added; 15 of those items are related specifically to health equity (Table 1). Cross-referencing these new subcompetencies led to an update to the self-assessment tool, consisting of 52 items.

Step 5: Adoption and Implementation

The NACDD board of directors formally adopted the recommended updated competencies in January 2018, and NACDD began dissemination activities. The Competencies are included in the NACDD Core Chronic Disease Competencies: Updated June 2016,[4] and the National Association of Chronic Disease Directors Competencies for Chronic Disease Practitioners, October 2016.[12] The Guide to Understanding and Using the Chronic Disease Competencies[13] was developed for easy member implementation of the Competencies.

Concept Systems, Inc (CSI), and NACDD leadership used the Competencies to support NACDD's increased commitment to professional development to pursue the following actions. First, to emphasize the priorities and activate member engagement in learning and professional development as an association priority, the PDC was reactivated as the Learning and Professional Development Committee (LPDC). Second, the LPDC formed 4 strategic working groups to focus on the recommendations from the report and address or complete each recommendation (Table 2). The recommendations included adopting the Competencies and developing a complete set of tools, as well as conducting a robust assets inventory to support member learning needs aligned with the Competencies. Third, CSI and NACDD leadership used NACDD's previous assessment tools as the basis for a newly designed, technology-supported assessment tool available for continuous access.[14] The assessment tool focuses on a subset of subcompetencies within the 7 chronic disease competency areas. First piloted at the September 2017 Chronic Disease Academy, the Chronic Disease Competencies Assessment Tool is now available for use in employee, manager, and team assessments within state and territorial chronic disease units. The tool is self-driven and provides explicit instructions for the user to provide ratings on each subcompetency in the self-assessment set, aggregate the ratings, score the ratings, and create an individual development plan that is a point-in-time blueprint.

The user and the manager both can revisit the plan and identify what progress has been made. The manager may also collect assessments from other team members and, via the capacity to aggregate across team members, conduct a team assessment to identify highlights, assess team progress, and notice gaps in the team's capacity to address needs. This process supports the manager in making hiring and coaching decisions as the program's needs change. The manager also has access to supporting tools in the tool kit. The job description builder and the interview planner are 2 tools that are included in the Assessment Tool. The data included can link to the Chronic Disease Competencies Assessment Tool to help in ongoing assessment. Further uses of the tool are described in the Guide to Understanding and Using the Chronic Disease Competencies.[13]