BACKGROUND: The local public health workforce in the United States is severely depleted, requiring a coordinated approach to re-build and repair the public health infrastructure to respond to community needs appropriately and efficiently. One important strategy is the recruitment of public health graduates by pipeline programs that recruit students to roles in local public health through applied practice experiences and enrichment activities. However, few published studies exist on pipeline programs that target local public health and of those that do, few describe components of their program, outcomes, and lessons learned to inform future adaptations, expansion, and replication. Rigorous evaluation is a necessity to inform training and career preparedness programs, barriers and facilitators to implementation of those programs, and outcomes and competencies that are most effectively achieved through the programs. These results inform future design and use of these programs to be most effective in training the next generation of public health professionals. This dissertation fills this evidence gap and aims to identify factors that support effective implementation and achievement of outcomes in the context of a specific pipeline program through a thorough scoping review and subsequent mixed methods evaluation.
METHODS: A two-pronged approach was used to address the aims. First, to understand the national landscape, a scoping review of peer-reviewed literature was conducted regarding public health work-education programs in the United States. The scoping review resulted in 34 programs and formed the basis for a typology of work-education programs. The typology classified differences across three program types and was differentiated by ten characteristics. Second, a mixed methods process and outcome evaluation was conducted on the Academic Public Health Corps (APHC) program in Massachusetts, a 160-hour, public health student workforce pipeline program established in 2021, to provide insights on a novel work-education program. The CDC Framework for Evaluation provided the foundation for the evaluation design and the Practical, Robust Implementation and Sustainability Model (PRISM) guided data collection and analysis. Study participants included stakeholders (e.g., APHC leaders and staff) and students, or “Corps members”. Quantitative data included stakeholder surveys (n=12), Corps member surveys (n=63) and qualitative data included key informant interviews (n=17), focus groups (n=4) and an assessment of APHC program artifacts. Thematic analysis and a matched pre-post survey design were used to identify the barriers and facilitators of the APHC program. Additionally, Corps member achievement of knowledge and skills were assessed across five domains as well as intention to pursue a career in local public health.
RESULTS: First, the scoping review and typology illustrated the spectrum of work-education programs and the significant variability that exists with each work-education program including the knowledge and skill objectives, applied practice experiences, mentorship, networking, and reflection. Second, the mixed methods evaluation revealed the APHC program increased local health department capacity through student-based project assignments and provided a positive learning experience for students. Pre- and post-survey resulted in mean increases in select competencies within each of the five public health domains. Students indicated the APHC program enrichment activities exposed them to different career pathways in local public health, including the breadth and depth of roles available for new graduates. Post-survey results indicated that students are interested in pursuing a role in state or local public health. Qualitative findings provided further context with students’ need to continue to explore their career options and may require more time. Stakeholders and students noted barriers limiting the APHC as a pipeline program and qualitative findings suggest that there are critical gaps in program design and operating practices that would benefit from enhancement.
CONCLUSIONS: Rebuilding the local public health workforce requires strategies to recruit new talent to promote and preserve the health of communities. Collaboration between academic partners, State and Local Health Departments, and other community partners are needed to build pipeline programs that inspire students to pursue a career in local public health. This study explored an evaluation of a novel workforce pipeline program and identified best practices and lessons learned to support student public health recruitment. As state agencies, public health practitioners, associations, and/or local health departments contemplate a new program or enhance an existing program, the scoping review and mixed-methods evaluation identified five areas of consideration for successful program design: (1) defining the strategic vision of program, (2) using evidence-based approaches, (3) developing and defining collaborative partnerships, (4) establishing performance measurement standards, and (5) developing a sustainability and maintenance framework. / 2026-05-10T00:00:00Z
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/48740 |
| Date | 11 May 2024 |
| Creators | White, Karen M. |
| Contributors | Greece, Jacey A. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
| Rights | Attribution 4.0 International, http://creativecommons.org/licenses/by/4.0/ |
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