COVID-19 Health Education Activities: An Analysis of a National Sample of Certified Health Educations Specialists (CHES^®/MCHES^®) in Response to the Global Pandemic

Abstract

The National Commission of Health Education Credentialing, Inc. (NCHEC) created the Category 1 COVID-19 Claim Form Opportunity to document how Certified Health Education Specialists (CHES^®) and Master Certified Health Education Specialists (MCHES^®) assisted communities during the COVID-19 pandemic. Using data submitted by CHES^®/MCHES^® (n = 3,098 claim forms), the purpose of this study was to (a) describe the settings where CHES^® and MCHES^® completed their pandemic work and (b) assess differences in the type of pandemic work completed by CHES^® compared with MCHES^® based on specific Areas of Responsibility (AOR) for Health Education Specialists. Findings showed that CHES^® and MCHES^® engaged in seven AOR during the pandemic, with the largest proportion of CHES^® (n = 859; 33%) and MCHES^® (n = 105; 21.9%, documenting COVID-19-related activities in health departments. CHES^® reported higher engagement than MCHES^® in activities such as COVID-19 reporting/tracking, χ² (1, N = 3,098) = 27.3, p < .001; outbreak response, χ² (1, N = 3,098) = 4.3, p = .039; and vaccination, χ² (1, N = 3,098) = 5.2, p = .023. Conversely, MCHES^® reported higher participation than CHES^® in screening/testing, χ² (1, N = 3,098) = 174.2, p < .001; administration of budgets/operations, χ² (1, N = 3,098) = 30.1, p < .001; and adapting educational activities at college/universities, χ² (1, N = 3,098) = 46.1, p < .001. CHES^® were more likely than MCHES^® to indicate working in all AOR except for Area 2—Plan Health Education/Promotion. Results support that employer-verified health education skills in all AOR were transferable during COVID-19, especially for CHES^® employed within state/county health departments.

Background

Effects of the COVID-19 pandemic have been felt worldwide, spanning from the fear and devastation of the virus to restrictions placed on social, work, and school practices. The first identification of SARS-CoV-2 was reported in 2019 (Cevik et al., 2020). Due to the evolutionary nature of the virus and its impacts on people of older age groups, minorities, and individuals with chronic illness, many health education specialists (HES) became essential workers on the frontlines of the response (Chaney et al., 2020). Since the pandemic began, public health needs have been an ever-changing target. Amid the uncertainty, HES adapted their skills and applied them where needed, in an attempt to effectively provide support services for the public (Hancher-Rauch et al., 2020).

A health education specialist (HES) is

An individual who has met, at a minimum, baccalaureate-level health education academic preparation. This individual must be competent in using appropriate educational strategies and methods to facilitate the development of policies, procedures, interventions, and systems conducive to the health and well-being of individuals, groups, and communities. (Joint Committee on Health Education and Promotion Terminology, 2021, p. 4)

The National Commission for Health Education Credentialing, Inc. (NCHEC), the sole certifying agency for health education/promotion, awards certification to Certified Health Education Specialists (CHES^®) and Master Certified Health Education Specialists (MCHES^®). CHES^® is the entry-level certification, while MCHES^® is the advanced-level certification. Both CHES^® and MCHES^® certifications signify that an individual has met the required academic preparation qualifications, has successfully passed a competency-based examination, and completes continuing education requirements (NCHEC, 2021).

CHES^® and MCHES^® serve in many capacities, including governmental agencies, nonprofit organizations, clinical or health care jobs, consulting, and academic careers (Chaney et al., 2020). Certificant holders in health education/promotion are trained to assess community health needs and plan, implement, and evaluate public health education/promotion programs. These professional responsibilities have been identified as critical in the approach to containing the spread of COVID-19 (Chaney et al., 2020). While Chaney and colleagues (2020) highlighted the transitions of CHES^®/MCHES^® to various critical roles by week 21 of the pandemic, the sample size was limited to 14 certificant holders, of which only five were able to complete semi-structured interviews about their COVID-19-related work. At this time, specific changes in the work-related responsibilities of CHES^®/MCHES^® during the pandemic remained unclear. However, the July 2022 Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention (CDC) summarized findings from the 2021 Public Health Workforce Interests and Needs Survey, which indicated that the pandemic strained essential frontline professionals, including public health and health education workers, as job roles shifted for a majority to focus fully or partially on the COVID-19 response (Hare Bork et al., 2022).

While the impact of COVID-19 has been abundant in all sectors of the workforce, there are potentially unique pandemic-related outcomes (e.g., a redirected focus from addressing other critical health issues) for the public health sector (Hancher-Rauch et al., 2020). Because HES have a highly sought-after and transferable skill set that can be applied to many conditions or diseases (Hancher-Rauch et al., 2020), it is important to understand how those skills have been applied during COVID-19. Hancher-Rauch and colleagues (2020) collected web-based survey data from 913 health professionals (79.9% CHES^®, 16.5% MCHES^®, and 2.5% Certified in Public Health [CPH] individuals), finding that 43% self-reported changing work priorities and 80% stated their work priorities shifted focus to COVID-19. Most HES felt qualified to take on new roles, but 41% of participants feared they could not return to their previous career focuses once the pandemic had passed (Hancher-Rauch et al., 2020). These changing priorities could adversely affect the public health workforce (e.g., burnout), including CHES^® and MCHES^®. More recently, Kerr and colleagues (2021) furthered this line of research by collecting survey data from 1,837 HES during the pandemic’s peak to assess their preparedness and involvement in the COVID-19 pandemic response. Kerr et al. (2021) demonstrated that HES self-reported significant involvement, in various roles and capacities, with the pandemic response and within the areas of responsibility (AOR) for Health Education Specialists. Continuation of this work, with larger samples of HES, would provide more generalizable results and implications for HES.

In March 2021, Yazel et al. (2022) conducted interviews with HES (n = 15) to examine perspectives on how their job roles shifted 1 year following the onset of the pandemic. Most participants reported a shift from their normal job priorities to those focusing on COVID-19. These changes ranged from a complete job role shift to picking up additional tasks to address the newly identified needs. Another theme that emerged was that the pandemic brought global attention to the field of public health. While health education/promotion was not at the forefront, like other subspecialties, such as epidemiology, it was a meaningful part of the global response.

To explore specific activities that HES were engaged in for required continuing education contact hours (CECHs) during the COVID-19 pandemic, in January 2020, NCHEC (2021) began gathering profile data from CHES^® and MCHES^®. The profile data were collected on NCHEC’s COVID-19 claim form, which required CHES^®/MCHES^® to document their COVID-19-related work activities for continuing education credits. Initially, this information was collected to provide required Category 1 credits to CHES^® and MCHES^® for their work during the pandemic. However, once the initial claim forms were processed, the goal was expanded to better understand how CHES^®/MCHES^® supported the public health response to COVID-19. Therefore, this study aimed to analyze and report COVID-19 claim form data describing HES’s responsibilities during the pandemic based on certification level (CHES^® or MCHES^®), work setting, type of activity, and by AOR for the field of health education.

Method

To conduct the secondary data analysis of the information submitted by CHES^®/MCHES^® during the COVID-19 Claim Form Opportunity (January 1, 2020, to December 31, 2021), NCHEC collaborated with research faculty from a large southeastern university. The research team created a protocol to examine the type of work conducted by CHES^®/MCHES^® during the pandemic, the setting where the work was being conducted, and in what specific AOR. A designated NCHEC staff member emailed all CHES^®/MCHES^® completing the COVID-19 Claim Form, informing them of the intended research project. In that message, CHES^®/MCHES^® were notified that de-identified, aggregated claim form data would be analyzed to better understand the work being done during the COVID-19 pandemic. Also, CHES^®/MCHES^® were allowed to “opt out” of having their data included in the analysis. To “opt out,” CHES^®/MCHES^® were asked to reply to the notification email stating, “I request that my Category I COVID-19 form data be excluded from the proposed analysis.” An Institutional Review Board (IRB) application was submitted and deemed exempt (IRB #21-0X-XXXX).

NCHEC’s staff produced de-identified spreadsheets for each COVID-19 Claim Form. All individual/identifying information was removed, and those spreadsheets were securely shared with the research collaborators for secondary data analysis. The research faculty trained 27 students as data coders, created a codebook for data analysis, and supervised the independent coding of the data for both CHES^® and MCHES^® claim forms. Of the 27 student data coders, two were PhD students, one an MPH student, and the remaining 24 coders were undergraduate students at the institution. The codebook produced to guide the coding process included the following entries: CHES^® or MCHES^® designation, level of activity—entry or advanced—based on the framework of practice for the field, description of the COVID-19 activities, work setting, AOR identified on the form, and health education Sub-competencies (MCHES^® only).

During the required student training, data coders were instructed on how to use the codebook, SPSS version 27 for data entry, and on the protocol for independently coding and verifying codes with other assigned coders. Students coded data in teams of two, and the study PI served as the third coder to resolve coding disputes between the two team members. During training, students were assigned five cases to code independently, and consensus discussions regarding the codes provided guidance to the coding process. Once agreement was met for five independently coded cases during training, the student coders began independently coding sets of cases, assigned to them by the study PI, and would subsequently meet to discuss consistency of codes and any discrepancies. For those discrepancies that were unresolved by the two student coders, the study PI would serve as the third coder to remedy discrepancies. Descriptive analyses were conducted using SPSS version 27. Moreover, 2 × 2 chi-square analyses were used to assess associations between the sample of CHES^® and MCHES^® on COVID-19 activities and the AORs engaged in the COVID-19 activities documented on the claim forms.

CHES^® or MCHES^® Designation

On the claim form, certificant holders indicated if they were CHES^® or MCHES^®. The codebook affixed a code of 1 to CHES^® and 2 to MCHES^® participants.

Entry-Level or Advanced-Level Activity

For each activity entered, participants documented if the COVID-19 activity was an entry-level or advanced-level activity, based on the framework of practice for HES (NCHEC, 2020). The codebook affixed a code of 1 to entry-level activities and 2 to advanced-level activities. This information was self-reported by CHES^®/MCHES^®.

Description of Activity Conducted

Certificant holders were asked to describe the COVID-19 activities they were documenting for Category 1 CECH credit on the claim form. The researchers developed a list of 29 activities based on claim form entries submitted by CHES^® and MCHES^®. For activities that did not fit into one of the 29 categories, an “other” code was created. Coders then entered the activity as a string variable into the SPSS file. Table 1 provides codebook categories for the type of activity submitted by participants.

Table 1.

Codebook for Type of COVID-19 Activity Conducted by Certificant Holder

(Type_Activity): What type of activity was conducted by the certificant holder? These will be in separate cells, so one claim form can have more than one activity selected. If no = 0; if yes = 1 (screening): COVID-19 screening/testing = 1 (training_hc_professionals): Development of program resources/trainings related to COVID-19 for health professionals in the workforce = 1 (contact_tracing): Contact tracing/COVID-19 reporting/tracking via electronic systems = 1 (care_triage): COVID-19 care coordination/triage (helping to coordinate assistance at local, state, and national levels for caring for COVID patients) = 1 (dev_protocols): Developing COVID-19 protocols for schools, worksites, and/or community organizations (such as churches) = 1 (health_ed): Creating/providing wellness coaching or patient/health education on COVID-19 to various individuals/communities = 1 (ed_activities_university): Adapting educational activities at the university-level because of COVID-19 (course revisions, graduation activities, etc.) = 1 (call_center): COVID-19 call/text center to take community calls = 1 (research_eval): COVID-19 evaluation and research (including grant writing) = 1 (communications): COVID-19 communications via social media or other forms of communication (press releases, web comments, webinars) =1 (ethnic_minority_materials): Creating/translating cultural appropriate COVID-19 materials for ethnic minority populations = 1 (health_needs_assessment): COVID-19 health needs assessments = 1 (quarantine_stations): COVID-19 quarantine stations = 1 (community_outreach): COVID-19 Community Outreach to provide resources for families (i.e., face coverings, hand sanitizer, food) = 1 (mental_health): Mental health counseling, stress management, and intervention services/programming to address mental health issues associated with the pandemic = 1 (vaccine): COVID-19 vaccination (organizing/providing vaccines in communities) = 1 (outbreak_response): COVID-19 outbreak response team = 1 (surveillance_data_analysis): COVID-19 surveillance and epidemiologic data analysis =1 (business_remediation): Development/implementation of resources for businesses for remediation/reopening = 1 (policy_dev): Development of local, state, and federal policies regarding COVID-19 = 1 (PPE): Providing PPE for COVID-19 protection = 1 (health_plans): COVID-19 health plan claims/support = 1 (post_COVID_19): Rehab/assistance/education for patients post-COVID-19 = 1 (antibody_testing): COVID-19 antibody testing = 1 (programs_adapted): Health education programs/information adapted formats for communities due to COVID-19 (i.e., online smoking cessation classes, virtual physical activity programs, diabetes education programs) = 1 (admin_operations): Administration of budgets, operations and staffing for COVID-19 activities =1 (prof_dev): Creating professional development related to COVID-19 = 1 (chair_univ_committee): Administration/Chairing university-level committees to direct campus care, and outreach related to COVID-19 = 1 (campus_training): Creating and implementing COVID-19 trainings for faculty at universities/colleges for reopening = 1 (other): an activity does not fit into one of the previous categories = 1 (other_text): If “other”, please specify: _______

Work Setting

The claim form captured the work setting for coders: (1) university/college, (2) health department, (3) hospital/clinic, (4) K–12 school, (5) public/community health agency (local, state, national), (6) business/industry (worksite), (7) nonprofit organization, and (8) other (only used if coders could not identify the setting from the list above). The workplace was self-reported by CHES^®/MCHES^® on their form, and coders used the eight setting codes to categorize that information.

Areas of Responsibility for Health Education Specialists (AOR)

The field of health education and promotion conducts a practice analysis every 5 years to verify the framework of contemporary practice in health education/promotion. The practice analysis is conducted in collaboration with NCHEC and the Society for Public Health Education (SOPHE), and the AOR for practice is verified during this rigorous analysis. “The core Responsibilities, Competencies, and Sub-competencies provide a comprehensive description of the profession, illustrating the knowledge and skills necessary to perform the daily tasks as a health education specialist” (NCHEC, n.d.). For the COVID-19 claim form, NCHEC used the seven AOR verified by the Health Education Specialist Practice Analysis (HESPA, conducted in 2015), because the claim form opportunity began before the latest framework (HESPA II, conducted in 2020) was rolled out and used for CECH requirements (NCHEC, 2020). The seven AOR verified in the framework by the HESPA (NCHEC & SOPHE, 2015) can be found in Table 2. The codebook included codes 1 to 7 to align with the AOR identified by the certificant holders. The AOR was self-reported by CHES^®/MCHES^®, and coders inputted the AOR that aligned with the activities provided on the form, recognizing that an individual activity could link to multiple AOR.

Table 2.

Areas of Responsibility for Health Education Specialists (NCHEC & SOPHE, 2015)

Area 1. Assess Needs, Resources, and Capacity for Health Education/Promotion Area 2. Plan Health Education/Promotion Area 3. Implement Health Education/Promotion Area 4. Conduct Evaluation and Research Related to Health Education/Promotion Area 5. Administer and Manage Health Education/Promotion Area 6. Serve as a Health Education/Promotion Resource Person Area 7. Communicate, Promote, and Advocate for Health, Health Education/Promotion, and the Profession.

Competencies Within the AORs for MCHES^® Only

The claim form required that MCHES^® identify the AOR and the advanced-level Competencies and Sub-competencies to which the documented COVID-19 activity was linked. Therefore, coders imported the self-reported Competencies and Sub-competencies for each activity for MCHES^® only. The Competencies and Sub-competencies were analyzed for this subsample and reported below.

Results

A total of 3,098 certificant holders’ claim forms were included in the study. This sample included all completed forms submitted during the claim form opportunity (January 2020—December 2021), excluding those who opted out (27 CHES^® and six MCHES^®). The CHES^® sample totaled 2,603 entry-level certificant holders (84.02%), while the MCHES^® sample included 495 advanced-level certificant holders (15.98%). All CHES^® claim forms documented entry-level activities, while the MCHES^® forms documented advanced-level activities.

Table 3 provides the frequency of CHES^® and MCHES^® activities documented on the claim form. The top three activities documented by CHES^® (n = 2,603) included (a) creating/providing wellness coaching or patient/health education on COVID-19 (n = 607, 23.3%), (b) contact tracing/COVID-19 reporting/tracking via electronic systems (n = 327, 12.6%), and (c) COVID-19 communications via social media or other forms of communication (n = 301, 11.6%). The top three activities documented by MCHES^® (n = 495) included (a) COVID-19 communications via social media or other forms of communication (n = 71, 14.3%); (b) creating/providing wellness coaching or patient/health education on COVID-19 (n = 69, 13.9%); and (c) administration of budgets, operations, and staffing for COVID-19 activities (n = 54, 10.9%).

Table 3.

Chi-Square Analyses of COVID-19 Activities Documented by CHES^® and MCHES^®

Activity	Frequency of CHES®	Frequency of MCHES®	Pearson χ2 (df)	p value
Creating/providing wellness coaching or patient/health education on COVID-19 to various individuals/communities	607 (23.3%)	69 (13.9%)	21.450 (1)	<.001**
Contact tracing/COVID-19 reporting/tracking via electronic systems	327 (12.6%)	22 (4.4%)	27.301 (1)	<.001**
COVID-19 communications via social media or other forms of communication for work setting/agency	301 (11.6%)	71 (14.3%)	3.042 (1)	.081
COVID-19 outbreak response team	231 (8.9%)	30 (6.1%)	4.268 (1)	.039*
COVID-19 vaccination (organization and providing vaccine in the community)	189 (7.3%)	22 (4.4%)	5.198(1)	.023*
COVID-19 screening/testing	171 (6.6%)	49 (9.9%)	174.290(1)	<.001**
COVID-19 surveillance and epidemiologic data analysis	140 (5.4%)	25 (5.1%)	0.89 (1)	.766
COVID-19 community outreach to provide resources to families (i.e., face coverings, hand sanitizer, and food)	135 (5.2%)	16 (3.2%)	3.425 (1)	.064
COVID-19 call/text center to take community calls	124 (4.8%)	18 (3.6%)	1.209 (1)	.272
Administration of budgets, operations, and staffing for COVID-19 activities	122 (4.7%)	54 (10.9%)	30.051(1)	<.001**
COVID-19 evaluation and research (including grant writing)	112 (4.3%)	29 (5.9%)	2.318 (1)	.128
Health education programs/information adapted formats for communities due to COVID-19 (i.e., online smoking cessation classes, virtual physical activity programs, and diabetes education programs)	103 (4.0%)	12 (2.4%)	2.734(1)	.098
Development of program resources/trainings related to COVID-19 for health professionals in the workforce	88 (3.4%)	17 (3.4%)	0.004 (1)	.95
Mental health counseling, stress management and intervention services/programming to address mental health issues associated with the pandemic	85 (3.3%)	16 (3.2%)	0.001 (1)	.970
COVID-19 health plan claims/support	78 (3.0%)	8 (1.6%)	2.936(1)	.087
COVID-19 care coordination/triage (helping to coordinate assistance at local, state, national levels for caring for COVID-19 patients)	76 (2.9%)	13 (2.6%)	0.128 (1)	.720
Developing COVID-19 protocols for schools, worksites, and/or community organizations (such as churches)	76 (2.9%)	17 (3.4%)	0.378 (1)	.539
Adapting educational activities at the university-level because of COVID-19 (course revisions, graduation activities)	69 (2.7%)	44 (8.9%)	46.051 (1)	<.001**
COVID-19 health needs assessment	58 (2.2%)	7 (1.4%)	1.342 (1)	.247
Development/implementation of resources for businesses for remediation/reopening	48 (1.8%)	7 (1.4%)	0.441 (1)	.507
Creating professional development related to COVID-19	34 (1.3%)	10 (2.0%)	1.514 (1)	.218
Providing PPE for COVID-19 protection in the healthcare setting	34 (1.3%)	6 (1.2%)	0.029 (1)	.865
Creating and implementing COVID-19 trainings for faculty at universities/colleges for reopening	34 (1.3)	7 (1.4%)	0.000 (1)	.990
Creating/translating culturally appropriate COVID-19 materials for ethnic minority populations	28 (1.1%)	13 (2.6%)	7.657 (1)	.006*
Development of local, state, federal policies regarding COVID-19	23 (0.9%)	5 (1.0%)	0.074 (1)	.785
COVID-19 quarantine stations	19 (0.7%)	6 (1.2%)	1.208 (1)	.272
Rehab/assistance/education for patients post COVID-19	19 (0.7%)	7 (1.4%)	2.340 (1)	.126
Administration/Chairing university-level committees to direct campus care, outreach on-campus related to COVID-19	17 (0.7%)	12 (2.4%)	14.069 (1)	<.001**
COVID-19 antibody testing	4 (0.2%)	1 (0.2%)	0.060 (1)	.806
Total N	2,603	495

Note. CHES^® = Certified Health Education Specialist; MCHES^® = Master Certified Health Education Specialists; PPE: personal protective equipment.

^*p < .05. **p < .01.

For documented work settings, CHES^® most often listed: health department (n = 859, 33%), university/college (n = 420, 16.1%), hospital/clinic (n = 407, 15.6%), and public/community health agency (n = 377, 14.5%). For MCHES^®, the most frequently listed work settings were health department (n = 105, 21.9%), university/college (n = 90, 18.8%), public/community health agency (n = 72, 15%), and hospital/clinic (n = 40, 8.3%).

Table 4 provides the percent of work in each AOR by type of certification. The Areas most selected by CHES^® were Area 6 (n = 1,149, 45.9%) and Area 7 (n = 1,091, 41.9%). The Areas most selected by MCHES^® were Area 7 (n = 172, 34.7%) and Area 2 (n = 159, 32.1%). For MCHES^® only, the top Competencies and Sub-competencies listed were (a) Competency 1.1—Plan assessment process (n = 100, 20.2%), (b) Sub-Competency 6.3.3.—Provide expert assistance and guidance (n = 94, 19%), (b) Competency 1.2—Access existing information and data related to health (n = 90, 18.2%), (d) Sub-Competency 3.2.4—Develop training using best practices (n = 85, 17.2%), (e) Sub-Competency 6.3.2—Prioritize requests for assistance (n = 81, 16.4%), and (f) Sub-Competency 3.2.5.—Implement training (n = 81, 16.4%).

Table 4.

Chi-Square Analyses of CHES^® and MCHES^® COVID-19 Work Reported in Seven Health Education AORs

AOR	CHES®	MCHES®	Pearson chi-square	p value
Area 1—Assess Needs, Assets & Capacity	491 (28.5%)	98 (19.8%)	15.9 (1)	<.001**
Area 2—Plan Health Education/Promotion	872 (33.5%)	159 (32.1%)	0.54 (1)	.567
Area 3—Implement Health Education/Promotion	1,042 (40%)	122 (24.6%)	41.6 (1)	<.001**
Area 4—Evaluation/Research Related to Health Education	883 (33.9%)	109 (22%)	27.4 (1)	<.001**
Area 5—Administer & Manage Health Education/Promotion	699 (26.9%)	100 (20.2%)	9.6 (1)	.002*
Area 6—Serve as a Health Education/Promotion Resource Person	1,149 (45.9%)	139 (28.1%)	54.1 (1)	<.001**
Area 7—Communicate, Promote & Advocate for Health, Health Education/Promotion and the Profession	1,091 (41.9%)	172 (34.7%)	8.9 (1)	.003*
Total N	2,603	495

Note. AOR = adjusted odds ratio; CHES^® = Certified Health Education Specialist; MCHES^® = Master Certified Health Education Specialists.

^*p < .05. **p < .01.

The relationship between certification type (CHES^® and MCHES^®) was statistically significant for nine of 29 (31.03%) activity categories (see Table 3 for chi-square results). The proportion of CHES^® reporting engagement in creating/providing wellness coaching, contact tracing/COVID-19 reporting/tracking, COVID-19 outbreak response, and work with the COVID-19 vaccination was significantly higher than MCHES^®. However, the proportion of MCHES^® reporting engagement in COVID-19 screening/testing, administration of budgets/operations related to COVID-19, adapting educational activities at a university-level, creating/translating culturally appropriate COVID-19 materials, and administration/chairing university-level committees to direct campus care and outreach was significantly higher than that reported by CHES^®.

The relationship between the type of certification (CHES^® and MCHES^®) and which AOR was indicated on the claim form was statistically significant (p < .05) for all AOR except for Area 2. As described in Table 4, the proportion of respondents who reported being CHES^® and entry-level were more likely than MCHES to indicate working in Areas 1, 3, 4, 5, 6, and 7. Area 2 did not differ by certification type (see Table 4).

Discussion

As captured on NCHEC’s COVID-19 claim form, over 3,000 CHES^®/MCHES^® engaged in activities related to the pandemic response within the 7 AOR. This indicates the verified skill set of CHES^®/MCHES^® prepared certificant holders to adapt and pivot to focus on COVID-19 issues during the global emergency, a finding also noted by Kerr et al. (2021) and Hancher-Rauch et al. (2020).

For CHES^®, the most documented AOR was Area 6; for MCHES^®, the most documented AOR was Area 7. This finding contrasts somewhat with the Kerr et al. (2021) study that reported MCHES^® were more likely than CHES^® to act as a resource person for COVID-19. Hancher-Rauch et al. (2020) reported that 36.2% of health educators worked on “chronic disease/disease prevention” for the majority of their work time during the pandemic. However, the specific type of COVID-19 tasks completed in that domain was not reported. Kerr et al. (2021) found that the top two job responsibilities related to COVID-19 were planning, implementing, and evaluating education and prevention programs (64.6%) and designing and/or implementing health communications about the pandemic (47.3%). Kerr et al. also showed that over 71% of respondents applied AOR related to Area 6 (e.g., determining factors that affect communication with audiences, setting objectives and constructing messages, and establishing methods and technologies for delivery and evaluation communications).

Study authors found that CHES^® working at the entry-level were more likely than MCHES^® to indicate working in all AOR except for Area 2. This finding contrasts with Kerr et al. (2021), who found that MCHES^® were more likely to perform most COVID-19 activities based on the health education AOR, except for contact tracing and direct care to COVID-19 patients, which were more likely to be conducted by CHES^®. However, results from this study support Kerr et al.’s finding that CHES^® conducted contact tracing more than MCHES^®. While the proportion of CHES^® (n = 76, 2.9%) and MCHES^® (n = 13; 2.6%) involved in COVID-19 care coordination/triage within this study was approximately the same as what was reported by Kerr et al., they reported that CHES^® were more likely to be involved in providing direct care to COVID-19 patients. This study found no such significant difference. In addition, this study found no significant differences in COVID-19 policy development/engagement between CHES^® and MCHES^® (p =.785), whereas Kerr et al. (2021) found MCHES^® were more engaged than CHES^® in creating COVID-19 policies and advocating about COVID-19. Also, this study found no significant differences between CHES^® and MCHES^® engagement in COVID-19 communications via social media or other forms of communication (p =.081); however, Kerr et al. (2021) noted that MCHES^® were more likely to design or implement health communications about the pandemic. Finally, this study’s finding that more MCHES^® engaged in administrative work (i.e., budgets, operations, and chairing committees on the pandemic response) than CHES^® aligns with the findings of Kerr et al. (2021).

Although engagement in Area 2 was not significantly different between CHES^® and MCHES^® in this study, there were significant differences in how many times CHES^® documented working in the six other AORs as compared with MCHES^®. Kerr et al. (2021) found that MCHES^® were more likely than CHES^® to assist with pandemic planning. However, it is important to note that Kerr et al. (2021) reported the frequency of CHES^®/MCHES^® who applied AORs to COVID-19, not specific differences in AOR application between CHES^® and MCHES^®. Furthermore, Kerr et al. (2021) combined the planning and implementation AORs on their questionnaire, which may have increased the potential for response bias when HES considered their COVID-19-related activities. In contrast, this study considered Areas 2 and 3 as separate AORs for CHES^® and MCHES^®. In addition, NCHEC’s COVID-19 claim form required the separation of COVID-19 activities into each AOR.

The top work setting for both CHES^® and MCHES^® was the state/county health department (n = 964), followed by the university/college setting (n = 510). These top settings were similar to those documented in both the Kerr et al. (2021) and Hancher-Rauch et al. (2020) studies. However, this study captured data from a larger sample of CHES^®/MCHES^®. Important to note, the COVID-19 claim form opportunity was opened to all 15,750 certificant holders, and 19.7% were included in this claim form analysis. While this study did not specifically examine changes in work roles for these professionals, the claim form does show that these professionals were either partially or fully engaged in COVID-19 work activities, suggesting that work roles for the participants did shift toward new pandemic-related work. This result supports the findings of Yazel et al. (2022), Kerr et al. (2021), and Hancher-Rauch and colleagues (2020). The shift of work roles suggests that continuing education opportunities should be offered to CHES^®/MCHES^® to provide additional training on managing these shifts during public health emergencies.

Limitations

This study provides the work setting and specific work activities CHES^® and MCHES^® conducted on the frontlines of the global COVID-19 pandemic. Nevertheless, there are several study limitations to mention. First, as a secondary data analysis, the data were not collected to answer specific research questions; the data provided on the claim form confined the analyses. In addition, only the variables collected on the form were available for inclusion in the study. For example, information about the demographic characteristics of certificant holders was not requested and thus could not be reported. Moreover, although the coding process allowed for coding discrepancies to be resolved by the study PI, consistency of student data coders, their assigned codes, and coding bias was a possibility and should be noted. Finally, the COVID-19 claim form opened before the official rollout of the newest AOR, which contains eight AOR; therefore, this study is based on the previous framework and seven AOR. As a result, COVID-19 activities related to several of the newest AORs, such as “Area 5—Advocacy” and “Area 8—Ethics and Professionalism,” were not coded for in the claim form dataset.

Implications for Practice and Research

This analysis of NCHEC COVID-19 claim form data expands on studies examining the roles of HES during the COVID-19 pandemic (Chaney et al., 2020; Hancher-Rauch et al., 2020; Kerr et al., 2021; Yazel et al., 2022) by providing employer-verified documentation of the crucial role that CHES^®/MCHES^® played in the COVID-19 response. Without question, the multifaceted skill set of HES was transferable and arguably essential for responding to the COVID-19 pandemic. Specifically, three key implications for practitioners regarding pandemic response, include (a) effective health communication strategies are essential skills for both entry- and advanced-level HES during a global crisis, (b) the ability to create tailored patient/health education materials in an expedient way is a needed skill for both entry- and advanced-level practitioners, and (c) there is a need for both entry-level and advanced-level trained HES in the workplace, as roles varied across certification level. MCHES^® reported being more engaged in administration work (budgets, operations, and staffing related to COVID-19 activities), and CHES^® reported being more engaged in contact tracing and reporting/tracking. This knowledge provides valuable information for the professional training of future HES at both levels of practice in the field. In addition, future research needs to be conducted to assess how shifting in job roles of CHES^® and MCHES^® were either maintained or returned to “normal” as the COVID-19 needs and work demands change.