Abstract
Objective:
To assess perceptions of effective communication training needs among US state and local government public health employees and examine variations across generations and other worker characteristics.
Design:
Cross-sectional survey analysis using data from the 2024 Public Health Workforce Interests and Needs Survey.
Setting:
State health agencies and local health departments across 48 states in the US.
Participants:
A total of 56 595 state and local government public health employees (37% response rate) representing 4 generations: Baby boomers (16%), Gen X (39%), millennials (38%), and Gen Z (7%).
Main Outcome Measures:
Training needs for effective communication, defined as the combination of ability to communicate effectively across audiences and ability to communicate persuasively. Training needs were identified when respondents rated skills as moderately or very important but reported being unable to perform or at beginner level.
Results:
Overall, 11% of respondents identified a training need for effective communication, including 7% with gaps in communicating effectively with different audiences and 9% in persuasive communication. Gen Z staff ranked persuasive communication as their top training need regardless of skill level. Logistic regression revealed that Communications and Policy staff (adjusted odds ratio 1.46, 95% CI 1.21-1.76) and Environmental Health staff (adjusted odds ratio 1.20, 95% CI 1.04-1.37) had higher odds of prioritizing communication training. Women and older generations were less likely to prioritize communication training compared to men and Gen Z, respectively.
Conclusions:
Although effective communication was identified as a training need, respondents did not consistently identify effective communication as their top perceived training need. Given the importance of communication to effective public health practice, training interventions should be tailored to different generations, roles, and programmatic areas.
Keywords: effective communication, persuasive communication, public health workforce, training needs
Introduction
Communication skills is a core competency for public health practitioners and is necessary for effective public health practice.1 This core competency is the ability to determine communication strategies, communicate with internal and external audiences, respond to information, misinformation, and disinformation, and facilitate communication among individuals, groups, and organizations.1 Communicating effectively to inform and educate is also 1 of the 10 Essential Public Health Services.2 The National Academy of Medicine has identified communication as an area of competency development.3 Communication is a cornerstone of effective public health practice, whether to inform and educate or to persuade and promote change or action.4
Recent public health emergencies, such as the COVID-19 pandemic and measles outbreaks in some states in the US, demonstrate the significance of public health professionals’ ability to communicate health risks, describe actions to take, encourage practice and policy changes, and shape narratives to protect and promote the public’s health.5 The communications landscape is evolving in an environment of increasing politicalization of health information,5,6 public health misinformation (false information), and disinformation (false information intended to mislead),7-9 and growing availability of and access to health-related information through technology innovations, such as generative artificial intelligence.10,11
Along with the evolving landscape of how public health communications are shared, there have also been changes in trust in public health institutions and officials. Trust is the foundation of receiving and acting upon communication.12 Thus, communicating effectively to shift public perceptions, encourage health-promoting actions, and build trust is more important now than ever to protect health.
Most public health professionals believe that communication is a skill that is important to their work, regardless of programmatic area and supervisory status.13 Despite the importance of communication to public health practice, not all public health professionals believe they have the necessary skills to be effective communicators. As defined by the de Beaumont Foundation, effective communication is “an interactive process of partnership and dialogue that leads to the exchange of information and ideas with a variety of groups in order to influence behaviors, policies, and social norms.”14 Public health professionals have identified effective communications as a training interest regardless of programmatic expertise, supervisory status, public health agency setting, and public health degree attainment.15 For instance, 19% of state and local government public health employees identified effective communication as a training need in 2021,16 up from 17% in 2017.17 However, communication-related training needs may also vary across age and generations. As a new generation of public health professionals enter the workforce,18,19 understanding how communication-related training needs differ across the generations and other characteristics can provide invaluable insight to institutions that train and employ public health professionals.
This study assesses perceptions of effective communication as a training need among US state and local government public health employees. This study will also examine variations in effective communication training needs across generations and other characteristics. This study uses data from the Public Health Workforce Interests and Needs Survey (PH WINS) collected in 2024. Effective communication is one training need domain in the PH WINS, which includes the ability to communicate across different audiences and persuasive communication.
Methods
The PH WINS was developed by the de Beaumont Foundation and the Association of State and Territorial Health Officials to understand the interests and needs of the state and local government public health workforce in the US. It was fielded in 2014, 2017, 2021, and 2024. It features several domains, including perceptions about the workplace environment, training needs, job satisfaction, and demographics/worker characteristics. The data analyzed in this study were drawn from the 2024 PH WINS.
The PH WINS 2024 was distributed online to 159 627 state and local government public health workers across 48 state health agencies and 1178 local health departments (LHDs). The PH WINS methods are more fully described by Robins et al.20
Analytic approach
The PH WINS includes a self-reported assessment of importance and proficiency for strategic skills organized across 10 domains, including effective communication. Effective communication was defined as a combination of 2 skills: ability to communicate effectively across audiences and ability to communicate persuasively. Respondents used a Likert scale to rate their perception of the importance of the skill to their current position (“not important,” “somewhat important,” “moderately important,” or “very important”) and their perceived proficiency in that skill (“unable to perform,” “beginner,” “proficient,” or “expert”).
A training need was identified if a respondent rated a skill as “moderately important” or “very important” to their current role and indicated that they were “unable to perform” the skill or were a “beginner.” Respondents then selected the most important item they would seek training on from a list of items they indicated were somewhat or very important to their jobs.
Descriptive statistics were performed, and inferential bivariate comparisons were made using Rao-Scott design-adjusted chi-square tests. The main independent variable of interest in this study is an indicator of generation based on age. Other independent variables of interest include supervisory status (nonmanager/tier 1, manager or supervisor/tier 2, or executive/tier 3), race/ethnicity, gender, programmatic area, formal public health training status, programmatic area. A design-adjusted logit model was fit where the dependent variable was whether the respondent had identified a communications strategic skill as the top item they would seek training for. The model included setting, program area, race/ethnicity, gender, supervisory status, age, whether a training need existed in the effective communication domain, highest degree attained, and tenure in public health practice. Fit statistics were calculated, and the model was assessed for collinearity.
Results
A total of 56 595 employees completed the survey, yielding a 37% response rate among eligible employees. Approximately 16% of the state and local workforce is of the baby boomer generation (born before 1965), 39% are Gen X (1965-1980), 38% are millennial (1971-1996), and 7% are Gen Z (1997-2010). Gen Alpha (after 2010) are not yet represented in the workforce (Table 1). Approximately 80% of the workforce are women, 62% are non-Hispanic white, 14% are Black/African American, and 13% are Hispanic/Latino (any). Regarding worker characteristics, 22% have formal public health training at any level, 72% are nonsupervisors, and 43% work in the public health sciences. A third work in State Health Agency-Central Offices, 43% in large LHDs, 21% in medium LHDs, and 5% in small LHDs. A full description of the workforce demographics is included in the Supplemental Digital Content Table 1, http://links.lww.com/JPHMP/B623
TABLE 1.
Demographics, Worker Characteristics, and Communications-Related Training Needs of the State and Local Public Health Workforce in 2024
| Unweighted | Weighted | |||
|---|---|---|---|---|
| n | % | n | % | |
| Age | ||||
| Baby boomers | 8414 | 14.9 | 37 227 | 15.6 |
| Gen X | 21 873 | 38.6 | 92 798 | 39.0 |
| Millennial | 21 945 | 38.8 | 90 503 | 38.0 |
| Gen Z | 4363 | 7.7 | 17 585 | 7.4 |
| Total | 56 595 | 100.0 | 238 113 | 100.0 |
| Public health training | ||||
| No public health degree | 44 002 | 78.2 | 184 791 | 78.1 |
| Public health degree | 12 238 | 21.8 | 51 783 | 21.9 |
| Total | 56 240 | 100.0 | 236 575 | 100.0 |
| Skill gap—Effective communication—Domain | 5618 | 10.7 | 23 535 | 10.7 |
| Skill gap—Different audiences | 3451 | 6.9 | 14 491 | 6.8 |
| Skill gap—Persuasive communication | 4260 | 8.7 | 17 798 | 8.6 |
| Greatest training need—Different audience | 4412 | 8.8 | 18 936 | 8.9 |
| Greatest training need—Persuasive communication | 4235 | 8.6 | 17 771 | 8.6 |
Overall, 11% of respondents identified a training need for effective communication. This includes 7% with a gap in communicating effectively with different audiences and 9% persuasively communicating. Nine percent of respondents identified communicating effectively with different audiences as the top skill they would seek training on, while another 9% prioritized persuasive communication. Respondent selection of effective communication as their top training priority varied by supervisory status and whether a gap was present. Although over 90% of respondents did not have a gap in the communications-related strategic skills (generally ranked within the bottom 3 by percent need), these skills were frequently selected as the top training priority (Table 2). An exception was observed among supervisors and managers, who rarely selected communicating persuasively as a top training need (16th-18th of 26).
TABLE 2.
Percent of Workforce Ranking Communications as Top Need, by Supervisory Status and Training Need Gap
| No Gap | Gap | Total | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| % No Gap | Rank No gap | % Top Need | Rank Top | % Gap | Rank Gap | % Top Need | Rank Top | Top % | Rank Top | |
| Nonsupervisors | ||||||||||
| Effectively target communications to different audiences | 92 | 1 | 9 | 4 | 8 | 25 | 10 | 3 | 9 | 4 |
| Communicate in a way that persuades others to act | 91 | 2 | 11 | 2 | 9 | 24 | 14 | 1 | 11 | 2 |
| Supervisors and managers | ||||||||||
| Communicate in a way that different audiences can understand | 96 | 1 | 11 | 1 | 4 | 26 | 12 | 2 | 11 | 1 |
| Communicate in a way that persuades others to act | 92 | 3 | 2% | 16 | 8 | 24 | 1 | 18 | 2 | 16 |
| Executives | ||||||||||
| Communicate in a way that different audiences can understand | 97 | 1 | 4 | 7 | 3 | 26 | 8 | 5 | 4 | 7 |
| Communicate in a way that persuades others to act | 96 | 2 | 5 | 5 | 4 | 25 | 12 | 2 | 6 | 4 |
Differences were marginal by age/generation. Among Gen Z staff, communicating persuasively was the top-rated most important need and communicating effectively with different audiences was third-highest, regardless of skill. Similarly, communicating effectively to different audiences was highly rated among millennials, as was communicating persuasively among millennial nonsupervisors, though it was not highly ranked among millennial supervisors and managers (Table 3).
TABLE 3.
Rank of Communications Strategic Skills as Top Need by Respondents, by Age and Supervisory Status
| Baby Boomers | Gen X | Millennial | Gen Z | Total | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| N | G | T | N | G | T | N | G | T | N | G | T | N | G | T | |
| Nonsupervisors | |||||||||||||||
| Effectively target communications to different audiences | 4 | 5 | 4 | 4 | 4 | 4 | 4 | 3 | 4 | 3 | 3 | 3 | 4 | 3 | 4 |
| Communicate in a way that persuades others to act | 1 | 1 | 1 | 2 | 1 | 2 | 2 | 1 | 2 | 2 | 1 | 1 | 2 | 1 | 2 |
| Supervisors and managers | |||||||||||||||
| Communicate in a way that different audiences can understand | 2 | 2 | 2 | 1 | 2 | 2 | 1 | 2 | 1 | 2 | 1 | 1 | 1 | 2 | 1 |
| Communicate in a way that persuades others to act | 15 | 10 | 16 | 16 | 17 | 16 | 16 | 20 | 16 | 16 | 18 | 16 | |||
| Executives | |||||||||||||||
| Communicate in a way that different audiences can understand | 10 | 11 | 7 | 4 | 7 | 8 | 4 | 7 | 7 | 5 | 7 | ||||
| Communicate in a way that persuades others to act | 4 | 2 | 4 | 6 | 3 | 6 | 4 | 5 | 4 | 5 | 2 | 4 | |||
Abbreviations: N, no gap; G, gap; T, total.
A logistic regression model was fit with the selection of either communications-related item as the respondent’s top training priority serving as the dependent variable. Compared to the reference group (Assessment and Surveillance), a small number of program areas had higher adjusted odds, including when the respondent served in a Communications and Policy role (adjusted odds ratio [AOR] 1.46, 95% CI 1.21-1.76, P < .001) or an Environmental Health role (AOR 1.20, 95% CI 1.04-1.37, P = .01). Clinical Health Care, Communicable Disease Control, Maternal Child Health, and Organizational Competencies staff all had statistically significant AORs below the referent. Women and all other genders were less likely than men, all else equal, to self-rate communications as a top need (women: AOR .88, P <.001; all other genders, AOR .80, P = .30). Compared to Gen Z, all other age groups had a lower AOR (~.88) of self-rating communications as a top training priority. Compared to bachelor’s-trained staff, those with less than a bachelor’s degree more frequently selected communications as a top training priority, and graduate-trained staff were less likely (P < .01 in all cases). Having a training need in the effective communications domain was associated with a 1.25 AOR (95% CI 1.14-1.37, P <.001)(Table 4).
TABLE 4.
Logit Regression of Respondent Ranking Communications as Top Need
| AOR | 95% LB | 95% UB | P-Value | |
|---|---|---|---|---|
| Setting | ||||
| SHA-CO (ref) | 1 | |||
| BCHC LHD | 0.97 | 0.90 | 1.05 | .51 |
| Other LHD | 1.05 | 0.97 | 1.14 | .19 |
| Primary Program Area Categories | ||||
| Assessment and Surveillance (ref) | 1 | |||
| Chronic Disease and Injury Prevention | 0.95 | 0.78 | 1.15 | .59 |
| Clinical Health Care and Social Services | 0.86 | 0.77 | 0.96 | .01 |
| Communicable Disease Control | 0.79 | 0.69 | 0.90 | <.01 |
| Communications and Policy | 1.46 | 1.21 | 1.76 | <.001 |
| Emergency Preparedness and Response | 0.95 | 0.79 | 1.14 | .57 |
| Environmental Public Health | 1.20 | 1.04 | 1.37 | .01 |
| Maternal, Child, and Family Health | 0.84 | 0.75 | 0.95 | .01 |
| Organizational Competencies | 0.88 | 0.79 | 0.98 | .02 |
| Other | 0.94 | 0.77 | 1.16 | .55 |
| Race and Ethnicity Combined | ||||
| White (ref) | 1 | |||
| BIPOC | 0.98 | 0.91 | 1.05 | .48 |
| Gender | ||||
| Man (ref) | 1 | |||
| Woman | 0.88 | 0.81 | 0.96 | <.01 |
| All other | 0.80 | 0.53 | 1.22 | .30 |
| Supervisory status | ||||
| Nonsupervisor (ref) | 1 | |||
| Supervisor | 0.73 | 0.67 | 0.79 | <.001 |
| Manager | 0.49 | 0.43 | 0.56 | <.001 |
| Executive | 0.53 | 0.45 | 0.63 | <.001 |
| Age | ||||
| Baby boomers | 0.88 | 0.78 | 1.00 | .05 |
| Gen X | 0.87 | 0.77 | 0.98 | .03 |
| Millennial | 0.88 | 0.79 | 0.98 | .02 |
| Gen Z (ref) | 1 | |||
| Effective communication | ||||
| No Gap | 1 | |||
| Gap | 1.25 | 1.14 | 1.37 | <.001 |
| Highest degree attained | ||||
| No college degree | 1.14 | 1.03 | 1.26 | .02 |
| Associates | 1.10 | 0.99 | 1.23 | .09 |
| Bachelor’s (ref) | 1 | |||
| Master’s | 0.78 | 0.72 | 0.84 | <.001 |
| Doctoral | 0.76 | 0.66 | 0.88 | <.001 |
| Tenure in Public Health Practice, y | ||||
| 0-5 (ref) | 1 | |||
| 6-10 | 0.95 | 0.89 | 1.01 | .13 |
| 11-15 | 0.96 | 0.87 | 1.06 | .41 |
| 16-20 | 0.95 | 0.82 | 1.11 | .53 |
| ≥21 | 0.88 | 0.79 | 0.99 | .03 |
| Constant | 0.36 | 0.31 | 0.41 | <.001 |
Discussion
Effective communication presents a unique case within the landscape of public health training needs given its rating as among the top training priorities despite having a modest skill gap as identified by respondents. Our analysis suggests that effective communication is a highly desired training priority among public health professionals, and across supervisory status and generations. However, where individuals rate effective communication as or among the top training priorities, it is among the lowest training needs based on importance and skill compared to other domains. We also found that effective communication was a highly ranked training priority among specific programmatic areas, including Communications and Policy and Environmental Public Health.
Perceived training needs for effective communications exist in some amount (as a low-level skill gap) but are a higher self-rated training priority from respondents. This finding aligns with previous research that identified skills such as budgeting, finance, and systems and strategic thinking as the top reported training needs.21 The discordance between self-rated priorities and an identified training gap is worth exploring. Investigating how the public health workforce perceives the role of effective communication in other public health skills like finance and community engagement may also be beneficial.
Our analysis reveals that certain worker characteristics are more likely to be associated with effective communication as the top training priority, including by program area, gender, and potentially age. However, given the importance of communication to public health, the pervasiveness of effective communication being a self-rated top training priority is worth addressing, even though the gap in the workforce is modest.
It is important to parse the measured constructs as we consider the relative importance of effective communications. Training needs are construed as a combination of importance and proficiency. For self-rated importance, staff are asked to select the most important item they “would seek training on given your current responsibilities.” One potential explanation for the discordance is that basic proficiency is insufficient for respondents to feel comfortable regarding items that are very important in their day-to-day work. For instance, while 61% of nonsupervisors feel that effectively communicating to different audiences is “very important,” 24% rated their proficiency as “expert.” It is not expected that all public health professionals would reach expert levels in communication skills. However, it is essential to develop communication proficiency in those who are not yet at the highest skill levels, given the importance of communication in promoting and protecting the public’s health, regardless of job title or supervisory status, and its importance to other public health strategic skills, such as community engagement.
Persuading to act and communicating with different audiences are broad concepts; nuances within each skill cannot be specified via PH WINS data. There may be specific subskills or concepts that respondents may perceive as a training need, such as communicating with specific communities, using persuasion skills for different audiences (eg, the general public, policymakers, and other targeted stakeholders). A more nuanced understanding of specific communication skills should be pursued in future research. For instance, understanding specific skills related to persuading others to act and specific actions requiring persuasion, such as individual behavior changes and advocacy for policy and systems changes, can inform training design and implementation to improve communication skills.22 These subskills should be explored in future research to inform the development of effective training programs. Similarly, given that certain program areas ranked communication higher as a training compared to other programs, future research should assess specific programmatic needs.
Limitations
There are a few limitations to note. The first pertains to PH WINS administration and fielding. While the PH WINS is nationally representative, 2 State Health Agencies did not participate; a number of LHDs also did not participate. While complex survey weight adjustment should account for nonresponse, any differential nonresponse could still prove problematic. Second, this manuscript engages heavily with the notion of training needs. These were measured indirectly through a combination of self-rated importance and self-rated proficiency. The needs may be higher or lower, but self-rated proficiency does not comport with an objective measure of need. Relatedly, training needs were measured by self-perception, which may differ from perceptions from a supervisor, manager, or other leadership. Lastly, this study does not identify specific training needs within each domain, such as for specific populations or communication goals, such as persuading for policy advocacy or individual behavior change.
Conclusion
Public health professionals have a responsibility to effectively communicate to protect and promote health; addressing communication-related training needs can support the public health workforce with fulfilling their duties. Future research should focus on longitudinal assessments of communication training needs as the generational makeup of the public health workforce changes due to forces such as aging and retirement. Research on specific communication skills related to persuasion and adaptation across populations, including the roles of technology and integrating new communication theory and methods, could inform public health training to ensure that public health professionals can craft, share, and evaluate messages that promote health.
Implications for Policy & Practice
Effective communication was not consistently ranked as the top training need among supervisors and executives. Employees who were not supervisors or executives were more likely to identify effective communication as a top training need, indicating opportunities to focus communication training opportunities in public health education prior to joining the workforce and for on-the job professional development for those who are not supervisors or executives.
Interventions to increase communication skills and capacities should be tailored to meet the needs of different generations, roles, and programmatic areas.
Trust and relationship-building should be concepts addressed in both formal public health education and on-the-job professional development.
Increasing communication skills can increase public health employees’ self-efficacy, helping them share important messages, persuade others to act, and support building relationships across communities,23 which can lead to improved trust.
Footnotes
The authors would like to acknowledge the de Beaumont Foundation and the Association of State and Territorial Health Officials for fielding the Public Health Workforce Interests and Needs Survey.
The authors declare that they have no conflicts of interest.
Human participant compliance statement: The requirement of ethical approval for PH WINS 2024 was waived by the WCG Institutional Review Board (Western-Copernicus Group IRB) for studies involving humans.
Funding statement: This work is supported by funds made available from the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS), National Center for STLT Public Health Infrastructure and Workforce, through OE22-2203: Strengthening U.S. Public Health Infrastructure, Workforce, and Data Systems grant. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (http://www.JPHMP.com).
Contributor Information
Jessica Owens-Young, Email: jessica.owens-young@morgan.edu.
Jonathon P. Leider, Email: leider@umn.edu.
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