摘要：Objectives. We examined US health educators’ likelihood of adopting genomic competencies—specific skills and knowledge in public health genomics—into health promotion and the factors influencing such likelihood. Methods. We developed and tested a model to assess likelihood to adopt genomic competencies. Data from 1607 health educators nationwide were collected through a Web-based survey. The model was tested through structural equation modeling. Results. Although participants in our study were not very likely to adopt genomic competencies into their practice, the data supported the proposed model. Awareness, attitudes, and self-efficacy significantly affected health educators’ likelihood to incorporate genomic competencies. The model explained 60.3% of the variance in likelihood to incorporate genomic competencies. Participants’ perceived compatibility between public health genomics and their professional and personal roles, their perceptions of genomics as complex, and the communication channels used to learn about public health genomics significantly related to genomic knowledge and attitudes. Conclusions. Because US health educators in our sample do not appear ready for their professional role in genomics, future research and public health work-force training are needed. The Human Genome Project has motivated extensive research and technological developments regarding genetics and genomics. Because most diseases can be associated either with single genes, with multiple genetic variations, or with interactions between genes and environment, advancements in genomic knowledge stand to affect public health—in its quest to improve the biological, environmental, social, and educational conditions fostering health promotion—in unprecedented ways. 1 , 2 An emerging field, public health genomics, focuses on “the study and application of knowledge about the elements of the human genome and their functions, including interactions with the environment, in relation to health and disease in populations.” 3 This focus signals important “changes in the landscape” of public health 2 , 4 and requires that public health workers develop new professional skills. Health promotion scholars, 5 , 6 alongside many professional organizations and agencies such as the American Public Health Association (APHA), 7 the Institute of Medicine, 1 the National Coalition for Health Professional Education in Genetics, 8 and the Centers for Disease Control and Prevention (CDC), 9 have advocated the adoption of specific genomic competencies by the public health workforce. What Caumartin, Baker, and Marrs affirmed of public health students applies invariably to all public health professionals: Students of Public Health do not need to be geneticists. They should, however, be public health specialists who possess an understanding of how the application of human genetic information and technology is creating a paradigm shift in public health and prevention strategies. 10 (p569) The term “genomic competencies” refers to specific skills and knowledge in public health genomics. 5 , 9 According to the CDC, 9 as members of the public health workforce, health educators should develop 7 specific genomic competencies (Table 1 ▶ ). Although these genomic competencies have been defined and proposed, to the best of our knowledge, no studies have examined whether health educators in the United States are ready to adopt them into their health promotion practice. TABLE 1— US Health Educators’ Likelihood of Adopting 7 Genomic Competencies Into Health Promotion Genomic Competency Not Likely at All, % Not Likely, % Somewhat Likely, % Extremely Likely, % 1: Translating complex genomic information for use in community-based health education programsa 40.3 36.6 20.7 2.4 2: Facilitating genomic education for agency staff, administrators, volunteers, community groups, and other interested personnelb 36.7 39.4 21.2 2.6 3: Developing a plan for incorporating genomics into health education services by working with community organizations, genomic experts, and other stakeholdersc 32.2 39.4 23.1 5.2 4: Conducting a needs assessment for community-based genomic education programsd 29.0 37.0 26.6 7.4 5: Advocating for community-based genomic education programse 28.0 41.0 26.6 4.5 6: Integrating genomic components into community-based genomic education programse 27.0 38.1 30.3 4.5 7: Evaluating the effectiveness of community-based genomic education programsf 29.5 40.6 24.5 5.4 Open in a separate window aModified from the Centers for Disease Control and Prevention’s (CDC’s) Genomic Competency 1. bModified from the CDC’s Genomic Competency 4. cModified from the CDC’s Genomic Competency 5. dModified from the CDC’s Genomic Competency 6. eModified from the CDC’s Genomic Competency 7. fCreated by the authors. In fact, given the newness of the field, little research is available regarding relevant issues in public health genomics. In tandem with our previous report on health educators’ knowledge and attitudes toward genomics published in Genetics in Medicine , 11 the study described here represents an initial step toward better understanding genomics-related elements and their impact on public health practice. In this report, health educators in the United States are offered as a case study from which careful extrapolations to the entire public health workforce might be appropriate. In our previous study, we assessed US health educators’ attitudes toward genomic competencies, their awareness of efforts in the field to promote and incorporate genomics, and their basic and applied genomic knowledge. Findings indicated that the sample espoused negative attitudes toward genomic competencies, low awareness levels, and deficient knowledge. Yet exposure to training in genetics and genomics appeared to influence attitudes, awareness, and knowledge. 11 In this study, we examined health educators’ likelihood of adopting genomic competencies into health promotion research and practice and the factors that might influence such likelihood. We proposed a conceptual, theory-based model, grounded in 4 behavior change theories: diffusion of innovations theory, 12 the theory of planned behavior, 13 the health belief model, 14 and social cognitive theory. 15 Findings from qualitative, in-depth interviews with 24 health educators also informed the development of this model (Figure 1 ▶ ). Open in a separate window FIGURE 1— Theoretical model of US health educators’ likelihood of adopting genomic competencies into health promotion research and practice. We tested the model using structural equation modeling techniques, applied to a nationwide sample of US health educators. We chose structural equation modeling because it is a robust statistical technique that handles missing data efficiently, reduces type I error, calculates measurement errors for all variables in the model, simultaneously assesses all variables and their interactions as proposed in the model, and most importantly, examines the “fit” of the hypothetical model to empirical data. 16 We sought to answer 4 specific questions: (1) How likely are health educators to adopt genomic competencies into health promotion research and practice? (2) Does the proposed model adequately explain health educators’ likelihood of adopting genomic competencies? In other words, is the model helpful for understanding what shapes health educators’ likelihood of adopting genomic competencies? (3) How much variance in the likelihood variable is accounted for by the predictor variables in this proposed theoretical model? (4) Which variable in the theoretical model is the best predictor of health educators’ likelihood of adopting genomic competencies into health promotion research and practice? Does this variable differ significantly from other variables?
