Summary

Participants value DHPE largely because it is a group of their peers and provides many opportunities to network and build relationships with this group.

However, they voiced a number of concerns and frustrations, many of which could be alleviated with changes in the quantity, frequency and content of DHPE communications, as discussed in the recommendations below.

Recommendations for Improving Member Communications

¨ Issue a quarterly newsletter via e-mail. The preferred format is likely to be brief summaries with links to full-text on the web site. Contents should include updates on DHPE activities as well as policy updates likely to affect DHPE members and announcements of upcoming events.

¨ Update the membership directory annually (if hard copy; more often if on web site), and inform participants when an update is available.

¨ Include DHPE in the subject line of all e-mail disseminated by the organization.

¨ Conduct a new member orientation session at the annual meeting, which might include a brief tour of the website and short (less than five minute) presentations on the role of each committee.

¨ Address members’ desire to see DHPE more actively involved in marketing health promotion and health education, and developing the public health workforce, by outreaching to the Association of State and Territorial Health Officials, the National Association of County and City Health Officials, Graduate Schools of Public Health, the American Public Health Association and perhaps the National Governors Association.

¨ Increase visibility of PHELI. It is highly valued, yet unfamiliar to some associates and potential members.

¨ Review membership records for accuracy, and improve membership tracking systems. Some associates had difficulty finding out from DHPE whether they were in fact current members.

¨ Prepare separate new member packets for voting and associate members. In each, clearly state the roles each can play. Include a form for new members to indicate the aspects of DHPE in which they would like to become more involved.

¨ Annually (perhaps as part of a dues mailing) ask members what committees they would like to join. Perhaps ask them to prioritize their top three choices (to ensure some committees do not become too large), but ensure that adequate opportunities exist for members to join committees of interest to them.

¨ DHPE voting members could call new members from their states and welcome them to DHPE. Regional trainings (discussed in the next section) would also provide new members with a chance to get to know nearby members and learn more about how to become involved.

Recommendations for Enhancing Professional Development Opportunities

¨ Develop a regionalization strategy for training, mentoring, and networking to augment the national conference.

¨ At the national conference, include sessions such as the National Health Education Leadership Summit and speakers with a broader policy point of view.

¨ Make available in a timely fashion tapes of national conference sessions, and include adequate descriptions for participants to determine which sessions would be useful in staff (or personal) development.

¨ Institute a moderated list serve to address peer-to-peer mentoring needs.

¨ Create (or continue) opportunities for mentoring relationships to develop naturally—through new member sessions and recreational time at conferences, by passing the names of new members on to their state’s director, through regional trainings, etc.

¨ Include basic skills information in the membership directory so that members can more easily identify other members who may have valuable experience on a specific issue.

Recommendations for Whether and How to Expand Associate Membership

¨ Before embarking on more aggressively marketing associate membership, clearly define the purpose of this effort and its benefits to DHPE and the potential members. This process should help clarify the types of new members that would be most beneficial to and most likely to benefit from DHPE.

¨ Examine how voting members are chosen in states where no one person is the director of health promotion or health education, and determine how to best ensure that these states’ needs are adequately addressed, either through multiple voting members or a more active identification and courting of associate members.

¨ Many members attend the national conference, sometimes many times, before joining the organization. If a new member orientation session is developed, it may make sense to make it a “new and prospective member” session as a means of approaching potential new members.

¨ Use an “honor system” application process. Clearly state the criteria for DHPE membership (perhaps at a minimum that the person be actively involved in public health education), but let individual applicants decide if they are right for the organization rather than having a formal application review process.

¨ Inform directors of new members in their states, and encourage them to contact new members and welcome them to the organization.

¨ Further explore how best to handle multiple members in state departments of health; consider whether membership should remain individual, as it is now, or should become “organizational” as CDD’s apparently is.

Background and Methodology

The Directors of Health Promotion and Education (DHPE) is in the process of re-branding itself and increasing its value to members. As part of this effort, DHPE has commissioned focus groups with current and potential members with the goal of getting a clear picture of their interests.

To that end, three computer-assisted telephone focus groups were conducted in November and December 2003; one group was with current voting members of the association, one with current associate members, and one with potential members. Study objectives were to explore:

How to improve association and peer-to-peer communication
How to increase members’ involvement in DHPE
How to support professional development of membership
If and how to expand associate membership

Participants were recruited from lists provided by DHPE. A total of 13 voting, associate and potential members participated in the focus groups, although considerably more had agreed to do so. Participating members had joined the organization 3 to 18 years ago.

Qualitative research of this sort provides rich, in-depth information that is most useful in understanding what and how people think, feel, and behave. However, because of the small number of participants, the way in which participants were selected, and the nature of the questioning (to stimulate discussion rather than administer an identical questionnaire), findings should not be assumed to represent the opinions of all current, associate and potential DHPE members.

Detailed Findings and Recommendations

This section is organized according to the major topics discussed in the focus groups:

¨ Perceived benefits of DHPE membership

¨ Enhancing member communications

¨ Increasing member involvement

¨ Enhancing professional development opportunities

¨ Whether and how to expand associate membership

Participants’ verbatim comments are indicated by italics or quotation marks.

Perceived Benefits and Role of DHPE

The opportunity to network with peers was the membership benefit most often mentioned and most highly valued by participants. Networking is important to members because it allows them to build relationships with others confronting similar challenges, and it enables them to reach out to those peers when they need help or ideas. A couple of associate members noted that DHPE is “not the kind of organization you see and say, ‘I want to join that organization,’” that joining is really due to one’s position in the health department. Many associates continue to stay because they see value in keeping up linkages to other members.

I would say that it's the networking and colleagues that have become really close friends throughout the years. And so besides knowing them through the Association and you often meet them at other conferences, and so it's really that networking and knowing that they have similar positions, similar challenges, similar frustrations … so that if you ever need to call someone you know who you can connect with. (Director)

The other thing that I get from it, that I value, is I think the clarification and understanding that comes from participating on conference calls and meetings with these people on some national perspectives and priorities sometimes that aren't always clarified through our funding agencies. And being able to kind of hash out those discussions and have some role with helping to set some national priorities. (Director)

… What I've always seen of ASTDHPPHE is that it does serve the purpose to work with the Public Health Departments in the state and that the association can facilitate things with health departments that CDC can't. And I think that there's a lot of value of the association to continue that relationship. (Associate)

I think for any discipline it's very helpful to have a discipline specific kind of professional group to be able to keep yourself updated with skills, training … just the networking opportunities … what other people are doing. (Potential member)

When potential participants were asked what DHPE offers its members, they mentioned the website and resources on it for competencies, the annual meetings, small amounts of grant funding for member to do projects with, and national awards.

Participants were also read the following list of DHPE offerings for voting and associate members and asked which offerings were most and least important to them.

¨ Updates on policies and programs related to health promotion and education

¨ Public Health Education Leadership Institute (PHELI)

¨ Distance learning and self-study programs

¨ Training and technical assistance

¨ National Conference on Health Education and Health Promotion, sponsored jointly with CDC

¨ Networking opportunities

¨ Service opportunities on various committees

Among these participants, networking opportunities, influencing national policy (especially for the directors), the national conference, and training opportunities, especially PHELI, were the most valued aspects of DHPE membership. However, it is important to note that some associate and potential members were not familiar with PHELI.

I would say that one of the things that is really important to me from the national organization is the opportunity to influence policy on a federal level and a national level. (Director)

[Influencing policy] would probably be followed by probably the training, which could be collapsed into the technical assistance and the national conference combination there. (Director)

… for example, I've taken advantage of the Public Health Leadership Institute and that's a benefit and something that I would not have been able, probably to participate if I had not been a member of ASTDHPPHE. (Associate)

My office has taken a lot of advantage of the Leadership Institute and it's been very good for us. And also the Conference is really great. (Potential member)

Other benefits mentioned included:

¨ One director mentioned the National Health Education Summit as something that had been really useful, but also as an example of where better communication would have helped in terms of providing context regarding the purpose of the activity.

¨ One potential member mentioned the following:

Access to some of the more practical programs or issues in public health education. Guidelines. Standards. A lot of the things that have come out lately. What's happening at the state level. Assessments and things of that sort are good resources for the field. So having access to those is worth joining.

While participants belong to other public health organizations, most didn’t see the others as fulfilling the same functions as DHPE. APHA and SOPHE were mentioned as organizations that included some of the same types of people but were much broader. The Chronic Disease Directors (CDD) and state public health associations were most often cited as serving similar functions, but even so participants generally thought of DHPE as unique. A couple of the directors noted that it has always been difficult to determine the respective roles of DHPE and CDD, and accordingly where to spend their energy.

I guess I see there are some other groups doing it but I don't think there are any groups that are doing it specifically for public health education which is really what I like. (Director)

A few participants articulated roles they would like to see DHPE expand or play:

I agree with what was said earlier … that lots of times it seems like, from my vantage point also, that health education is not marketed particularly well or other people in the health department don't know exactly what it is that health educators do. And that it can be helpful to have some kind of organization to clarify that or give you ammunition and materials and what have you to use with your leadership or other fellow professionals to say that this is our unique contribution to Public Health. (Potential member)

I would like to see some more attempts at linkages between ASTDHPPHE and the other professional organizations so that we are all working on the same page. (Associate)

…ASTDHPPHE, if it doesn't already have a role in the credentialing of the Public Health Workforce then it definitely needs to have a role. And I would assume it has a role but I don't know that for a fact. (Associate)

Enhancing Member Communications

Communications were a paramount concern to both voting and associate members, but particularly the latter. Many members seem to feel out of touch with the association, unaware of what it is doing or indeed even everything it offers, and they are unaware of any routine mechanism in place to update them on association activities. Quarterly teleconferences have made one director feel more in contact with DHPE; however, the same person did not know how or why the teleconferences began.

¨ Some associate members said they receive no communications from DHPE, or no communications other than their dues invoice.

I don't remember getting any kind of newsletter or any kind of communication from ASTDHPPHE, except the notice that my dues were … it was time to renew my dues. And that was essentially it. (Associate)

I would really like some communication. I don’t receive anything and I don’t know what associate members get or receive as a part of their membership. (Associate)

¨ All groups would like a regular newsletter that keeps them informed of DHPE activities and health promotion and education policy changes. When asked about the content, format, and frequency of the newsletter, a number of focus group participants prefaced their comments with concerns about not overtaxing limited resources at DHPE, and then attempted to come up with ideas that would not be too labor intensive. Associates thought a quarterly newsletter would be often enough, and that they would hate for someone at DHPE to have to spend a lot of time writing the newsletter. They suggested as an alternative that the newsletter could contain brief summaries linked to existing documents.

The Chronic Disease Directors … have just a very informal newsletter. I think at one time is was more formal but now it's just an electronic simple newsletter that they share an awful lot of kind of what's going on at CDC and updates and other resources and sometimes it just kind of points you to another link… it's one that I find I can just breeze through it really quickly and at least I feel that I know a little bit of what's going on. (Director)

I would really like to know what are the issues that they're dealing with? What are the programs they're working on? Do they have special committees that they need help with on certain projects? That's what I was kind of looking for and I didn't receive that or couldn't find it even on the website when I was looking at times. (Associate)

¨ Voting and associate members would like to see information shared more broadly, suggesting that all members be copied on information going to the voting members or the board, or that such information be put on the members-only portion of the website.

I'll call us the flunkies for no other reason … because I can't think of another term. But if there's something already going out to the Directors … I mean if the associate members can be included in that loop as well. (Associate)

¨ In general, associates and potential members did not know what membership benefits they should receive.

I think that if we just knew what opportunities were available to us I think that more associate members would take advantage of them. (Associate)

I think there's a lack of understanding about what the role of associate members are or could be and things of that nature. So if you're not a State Director, clarification of the roles of the associate members is something that I've heard people would like. (Potential member)

¨ Some also were unclear on what particular resources entailed.

I think I haven't utilized the Training and Technical Assistance so I'm not sure exactly in what context that would be available. A lot of times we'll just go for that from CDC or something like that. Clarification on what that resource is would be helpful. (Potential member)

¨ Many members (particularly associates) were unaware that DHPE publishes a membership directory. Those who were aware of it generally did not know the last time it had been published or whether it was currently available in hardcopy or online.

I’ve got to tell you, I don’t know what an annual directory is. (Director)

Some years we get one and some years we don't … about five to eight years [ago] at each annual meeting we had actually a three-ring binder that told you all about the organization … had all these nice tabs in it and had a wealth of information. In fact I still have my binder. And then at every annual meeting they would give us the insert to update the members. And I use that as like my resource. (Director)

¨ Voting members would like to see all email clearly marked as coming from DHPE, especially given frequent DHPE staff changes. One also noted that e-mails often are not set up with sufficient context:

[It will] be almost like the email starts in mid-sentence or mid-thought and I'm trying to figure out … okay, to what area does this pertain and is this an FYI or is it something that I need to take action on for the Association? And it's not always clear unless I go back and re-read the email several times. (Director)

Recommendations

¨ Issue a quarterly newsletter.

o Most participants were receptive to an e-mailed newsletter; a couple said they would prefer hard copy.

o If the newsletter is electronic, the favored format appeared to be brief summaries with links to full-text on the web site. Only a couple said they would prefer full-text in the newsletter itself.

o Contents should include updates on DHPE activities (to counter impressions that only the “in” group or those serving on the board or as committee chairs know what is going on) as well as policy updates likely to affect DHPE members and announcements of upcoming events.

¨ Update the membership directory annually (if hard copy), and inform participants when the update is available.

¨ Include DHPE in the subject line of all e-mail disseminated by the organization.

¨ One potential member suggested a new member orientation session at the annual meeting; others on that call were very receptive to the idea.

I recently went to a conference that had a, like a new member's orientation … like a little social or reception the evening of the conference. And the nice thing about that is that they actually had, on display, copies of their resources. Someone actually came up and did a quick navigation of their website. And it was about maybe an hour and a half, two hours long. And then you had different committee members there that gave like a two-minute presentation of what their committee did and gave you an opportunity. It was really nice because sort of within a short period of time [it] gave you a full scope of the organization. The nice thing I thought about the navigation of the website is I probably would not have gone on my own to their website unless I needed something. So it was a nice way of knowing of what's available to me without me having to go there first or go it alone. (Potential member)

Increasing Member Involvement

There appear to be a number of barriers to greater member involvement. As the bullets below illustrate, some are the result of perceived organizational dynamics and others the result of inadequate communications.

¨ There is a perception that committees are not open to all, and/or that committee membership tends to be static, with little opportunity to move to a different committee.

It seems like it's always the same people that are involved. (Director)

I agree with that. It seems like [once] you've signed up for a committee then they kind of think that that's your niche for life. (Director)

¨ A couple of directors would like to see more momentum with the board, saying it gets bogged down on a few issues and re-hashes old issues rather than moving forward once a decision has been made.

¨ Many associates probably do not know what roles they can play; for example, participants did not know if they could serve on committees. A couple of participants spoke of the importance of associates being able to hold some type of leadership positions for which they could receive recognition.

I could understand if associate members could not hold positions within the association. But I do think that they should be able to chair and lead committees. At least that's a level of leadership that they could be recognized for. (Potential member)

¨ Associates may feel “shut out” of the annual meeting to some extent; some participants mentioned that there is a meeting of the DHPE board at the annual meeting, but they do not know if they are permitted to attend and there is no separate associate function.

¨ There is no mechanism in place for periodically asking members what committees they would like to join. Some who are active committee members said they would like to switch committees . . .

… One thing that I do think would be good is when they send out the membership renewal … if we did have an opportunity, at that time, to sign up for various committees. (Associate)

¨ Some participants said they did not have the time to become more actively involved, or, for emeritus members, that being involved is no longer as important as when they were a state health promotion/education director.

Reasons given by people who were involved included the following:

I got involved because I saw so much being done and wanted to be a part of it and knew that it would help me move certain things forward in my state. And I think the learning process … of being part of something like this is very rewarding, professionally and personally. (Director)

It’s a ways that I can give back to the organization instead of just expecting the organization to be serving its members. (Director)

Recommendations

¨ Increase visibility of PHELI. It is highly valued, yet unfamiliar to some associates and potential members.

¨ Review membership records for accuracy, and improve membership tracking systems. Some associates had difficulty finding out from DHPE whether they were in fact current members.

Enhancing Professional Development Opportunities

Apart from participation in the Public Health Leadership Institute, voting members seemed to put professional development in the context of “trainings” for them personally or their staff. Associate and professional members tended to think of professional development as trainings for them personally.

¨ All groups preferred in-person trainings, with the national conference being the training forum most often mentioned. Directors expressed an interest in more frequent training opportunities, saying they would like two a year rather than one. One director offered a logical reason for their preferences:

For the most part people are much more interested in personal contact trainings than online kinds of trainings. That's an educated guess, I think. That this is not an organization … maybe something that was a more science and drew people who were much more individually focused would be better. But, I think, that for most of the health educators, health promotion kind of people I know … they want human contact. (Director)

¨ Directors had a couple of suggestions for content of the national conference to enhance its utility as a training vehicle:

o Include more speakers with a broader policy point of view; they noted this is something CDD does well.

o Include the National Health Education Summit training; they thought it would be useful in preparing directors to give testimony to state legislatures and getting them to think about whether it was something they should do at the next legislative session.

o One director described in more detail the conference sessions that work best as trainings:

But I don't like the Conference sessions which are just abstract where you just kind of whet the appetite as to what that project was about. I like more focused training where you are maybe taking an afternoon or a half day to be focused on one particular subject. (Director)

¨ Some of the directors were interested in regional trainings, noting that they would permit greater staff participation (due to reduced travel expenses), strengthen relationships with nearby colleagues, allow issues that are similar across a region to be addressed, and provide a forum to welcome and mentor new members.

¨ One potential member said it would be helpful to state staff to have a registry of articulate and eloquent speakers to call upon for state conferences.

A few used or expressed an interest in other training modalities, particularly satellite downlinks and videotapes. Although one person liked online trainings, a few others said they tended never to have the time to get to them.

¨ One director thought that training sessions downlinked via satellite were much more valuable than audio sessions, saying, “then they can usually post their slides and their visuals … so it's almost like sitting in a conference and you can bring your staff with you, as well as invite stakeholders that you work with.”

¨ Some voting members expressed a particular interest in tapes of sessions at the national conference, saying they often used them to train staff. However, one noted that it would be helpful if more comprehensive descriptions accompanied the tapes, because by the time the tapes are available it can be difficult to recall precisely which sessions were useful or exciting.

¨ One person advocated audio trainings to some degree, saying when they have co-sponsored some audio trainings they had been valuable.

¨ One potential member suggested tailoring professional development opportunities for associates:

I think certainly making things like … training opportunities or the distance learning and self study and networking [available to associates]. And maybe some of those could end up having a slightly different focus for people who were not the designated Directors in their own agencies or states. I could see where they could have some slightly different needs in those areas than the Directors themselves would … so maybe there could be some fine tuning of like the educational or training opportunities or what have you, and the networking that would help them. And then that, in the long run, would hopefully help them promote health education and health promotion back in their own systems. (Potential member)

The directors were the only group who really spoke to formalized peer mentoring programs, with a couple describing past DHPE activities where members listed their skills. Another noted that DHPE can pull together a team and provide technical assistance directly to a state, but “people don’t know about it.”

¨ Some participants were not optimistic about the chances of success for a formal mentoring program. One director thought it might no longer be realistic given the high turnover within states. The associates thought the idea of mentoring was good, but based on other experiences were pessimistic about it working operationally. They noted that many mentoring relationships work better when they develop informally rather than formally.

¨ Participants were generally receptive to a list server as a way of peer-to-peer mentoring via posting questions and getting suggestions back. They preferred a moderated list serve so that their e-mail volume would not get unmanageably high (as HEDIR’s does) and so that posts were relevant. One associate described a list serve run by ASTHO in which the moderator received all replies to a query, and then summarized them and posted the summary on the list serve, thereby reducing list serve volume substantially over those in which each response goes to all subscribers.

Recommendations

¨ Develop a regionalization strategy for training, mentoring, and networking to augment the national conference.

¨ At the national conference, include sessions such as the National Health Education Leadership Summit and speakers with a broader policy point of view.

¨ Institute a moderated list serve to address peer-to-peer mentoring needs.

¨ Include basic skills information in the membership directory so that members can more easily identify other members who may have valuable experience on a specific issue.

Whether and How to Expand Associate Membership

Voting, associate and potential members were generally supportive of expanding DHPE’s associate membership; however, they wanted to know the purpose of the expansion before offering unreserved support or ideas regarding how and with whom expansion might best be accomplished. A couple of potential members cautioned that if membership is opened up too broadly, DHPE runs the risk of becoming “just another special interest group.”

But if the goal was to expand membership to help move forward the goals of DHPE, I think there's room for a whole lot more different types of people …than we currently have. And many of those are working in state health departments. Some are working in universities and some are working at the local level. I think that … if you look at the membership of CDD, they utilize all these different types of people in their different capacities, and, because of that, CDD has formed strong linkages with these groups and get additional assistance, help, whatever you want to call it … joint collaboration efforts … that help move forward a lot of the national agenda items. (Director)

If the purpose of the organization is just to meet and network with the Directors of Health Education in each state, then I think we're accomplishing our mission. If the goal of this association is going to be broadened to help promote the field of health education, as well as health education practice in certain program areas, then I think we have a little bit bigger task ahead of us. And I have to tell you, from a state perspective, I would hope that they would look broadly at the second option, because … I'm seeing the field of health education waning because people are becoming specialists in other areas. …I'm really seeing the need for health education advocacy and promotion of the field as well as the practice of the principals in states. And so the more people that we can get to help with that I would think would benefit the Association. (Director)