Disease Intervention Specialist Education for the Future: An Analysis of Public Health Curricula

Abstract

Objectives:

The objectives of this study were to (1) determine the degree of alignment between an existing public health curricula and disease intervention specialist (DIS) workforce training needs, (2) assess the appropriateness of public health education for DISs, and (3) identify existing curriculum gaps to inform future DIS training efforts.

Methods:

Using the iterative comparison analysis process of crosswalking, we compared DIS job tasks and knowledge competencies across a standard Council on Education for Public Health (CEPH)-accredited bachelor of science in public health (BSPH) and master of public health (MPH) program core curricula offered by the Georgia Southern University Jiann-Ping Hsu College of Public Health. Four researchers independently coded each DIS task and competency as addressed or not in the curriculum and then discussed all matches and non-matches between coders. Researchers consulted course instructors when necessary, and discussion between researchers continued until agreement was reached on coding.

Results:

The BSPH curriculum aligned with 75% of the DIS job tasks and 42% of the DIS knowledge competencies. The MPH core curriculum aligned with 55% of the job tasks and 40% of the DIS knowledge competencies. Seven job tasks and 9 knowledge competencies were considered unique to a DIS and would require on-the-job training.

Conclusions:

Findings suggest that an accredited public health academic program, grounded in CEPH competencies, could address multiple components of DIS educational preparation. Similar analyses should be conducted at other CEPH-accredited schools and programs of public health to account for variations in curriculum.

Disease intervention specialists (DISs) conduct many tasks related to preventing the transmission of communicable diseases, such as HIV and other sexually transmitted infections (STIs). For example, DISs trace and then contact sexual partners of people diagnosed with STIs to ensure that they are evaluated and treated, thus reducing the likelihood of further transmission.^1-3 DISs also perform field investigations, such as contacting people who test positive for HIV but do not return for posttest counseling, or identifying and contacting people with HIV who are not in care.^4,5 DISs are often based in state or local health departments, although an increasing number of DISs are in clinics, where they conduct interviews to obtain information on sexual partners and their locations.⁶ The current DIS workforce in the United States, including community-based front-line workers and supervisors, is estimated to be 2063.⁷ DIS work involves the use of skills typically found within 2 areas of concentration in public health training programs: (1) health education and promotion and (2) epidemiology.

DISs are an integral part of the public health workforce, and because of the evolving role they play, focused training and skill development are necessary. Challenges in pursuing improvements in DIS workforce training include determining where to start and how to focus efforts. In its 2017 Job Task Analysis and Test Specifications Report, the Public Health Accreditation Board identified the diverse experiential and educational backgrounds from which DISs enter the public health workforce as a barrier to developing national DIS certification criteria.⁸ DIS training has historically relied on various nonstandardized approaches involving both formal education and on-the-job experience. Evaluating and, if needed, standardizing the educational curriculum for those pursuing a career as a DIS may be one starting point for addressing DIS workforce training deficiencies.

The 2003 Institute of Medicine report, Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century, recommended that academic public health programs embrace an ecological approach to curriculum development and educational delivery.⁹ The authors noted that this approach, which involves an awareness that health and well-being are affected by the interactions among multiple determinants of health, should contribute to the development of a competent public health and personal health care workforce. Others have maintained that to effectively train the public health workforce, it is essential to engage in an intentional and systematic review of public health educational delivery, while also focusing on the emerging needs of the public health practice community.^10-12 The call to action in the 2003 Institute of Medicine report highlighted the need for both the nation’s academic training programs and the public health practice–based community to promote a culture of continuous quality improvement and workforce development.^13,14

One way to evaluate whether academic public health training programs have the required content to effectively train a workforce is to conduct a gap analysis.¹⁵ The goal of such an analysis is to identify gaps between educational curricula and necessary workforce knowledge and skills. It is an approach that results in the grounding of strategies and policies for workforce training in public health practice. Our objective was to conduct a gap analysis to determine and quantify the gaps between the public health training currently available in one accredited college of public health, and the job tasks and knowledge competencies required of a competent DIS workforce. Determining the degree of alignment between the content of public health curricula and the job tasks and knowledge competencies needed by the DIS workforce may inform future DIS education and training strategies and policies.

Methods

Our gap analysis involved 5 steps: (1) outlining and validating the scope and objectives of the gap analysis through consultation with a Public Health Accreditation Board representative, (2) becoming familiar with and mapping the DIS workforce job tasks and knowledge competencies specified by the Accreditation Board’s Job Task Analysis and Test Specifications Report ⁸; (3) reviewing course syllabi and materials from the Council on Education for Public Health (CEPH)–accredited Jiann-Ping Hsu College of Public Health curriculum, to become familiar with and map the skills and knowledge offered within its core curriculum; (4) identifying gaps between the Jiann-Ping Hsu College of Public Health curriculum content and DIS workforce job tasks and knowledge competencies by using a crosswalk methodology (in which we were able to observe sufficient commonality of items across the curriculum and task or competencies)¹⁶; and (5) assigning to each identified gap 1 or more of 3 strategies (course, practicum, or on-the-job training) that could help align curricula with job tasks and/or knowledge competencies (Table 1). This research was reviewed by the Georgia Southern University Institutional Review Board and was approved as non–human subjects research.

Table 1.

Methodological steps in a gap analysis of core curricula for disease intervention specialist training

Step	Action
1: Identify scope of gap analysis.	Outlined and validated the scope and objectives of the gap analysis through consultative discussions with PHAB representative.
2: Determine desired job skills and knowledge competencies for a qualified DIS workforce.	Reviewed DIS workforce tasks and knowledge competencies outlined in the PHAB Job Analysis and Test Specifications Report. 13
3: Evaluate which skills and knowledge competencies are covered by a CEPH-accredited college of public health core curriculum.	Obtained core course syllabi and material and became familiar with the skills and knowledge offered through current curriculum of CEPH-accredited college of public health.
4: Identify gaps between core curriculum and designed DIS workforce job skills and knowledge competencies.	Identified gaps by conducting a crosswalk of core curriculum content with DIS workforce job tasks and knowledge competencies.
5: Recommend ways to fill gaps in the current BSPH and MPH core curricula.	Assigned to each identified gap 1 or more of 3 recommended strategiesa to increase alignment between core curriculum content and DIS workforce job tasks or knowledge competencies.

Abbreviations: BSPH, bachelor of science in public health; CEPH, Council on Education for Public Health; DIS, disease intervention specialist; MPH, master of public health; PHAB, Public Health Accreditation Board.

^aThe 3 recommended strategies used by professional degree programs, each having the potential to improve alignment between curriculum content and certain job tasks or knowledge competencies, were elective courses or adjustments to courses, practicums and experiential learning, and on-the-job training (skills obtained through work experience).

In step 1, we worked in consultation with a representative from the Public Health Accreditation Board to create a plan for the analysis and ensure that all the documentation needed to conduct the analysis was available.

In step 2, we examined the Job Task Analysis Report to determine the job tasks and knowledge competencies needed for appropriately qualified DISs. We organized the data in the report into 2 broad categories: (1) job tasks (56 tasks within 9 domains) and (2) knowledge competencies (103 competencies within 10 domains).

In step 3, we determined which DIS job tasks and knowledge competencies were addressed in 2 academic public health training programs at Georgia Southern University Jiann-Ping Hsu College of Public Health. We collected information about course objectives, competencies, activities, and assignments for all courses listed in Table 2. First, we reviewed the syllabi for the core courses of the bachelor of science in public health (BSPH) degree program (with a major in health education and promotion). Second, we reviewed the syllabi for the core courses of the master of public health (MPH) degree program. The core courses of both degree programs address the foundational competencies required by CEPH for program accreditation.

Table 2.

Core curriculum courses^a for the health education and promotion BSPH degree and MPH degree programs at the Georgia Southern University Jiann-Ping Hsu College of Public Health

Core Course No.	Core Course Name	No. of Credit Hours
BSPH degree in health education and promotion
Public health core
PUBH 2131	Introduction to community and public health	3
PUBH 3132	Health care systems and advocacy	3
PUBH 3136	Principles of environmental health	3
PUBH 3231	Epidemiology and biostatistics	3
PUBH 3330	Modifying health behaviors	3
Health education and promotion core
PUBH 3138	Multicultural factors and social determinants of health	3
PUBH 3131	Chronic disease: a modern epidemic	3
PUBH 3232	Foundations of health education and promotion practice	3
PUBH 4132	Health promotion program planning I	3
PUBH 4133	Health promotion program planning II	3
PUBH 4134	Research methods and evaluation	3
PUBH 4330	Promotional strategies for health programs	3
PUBH 4798	Internship health education and promotion/public health (not reviewed)	12
MPH degree
MPH core
PUBH 6532	Environmental health	3
PUBH 6533	Epidemiology	3
PUBH 6534	Health policy and management	3
PUBH 6535	Social and behavioral sciences	3
PUBH 6541	Biostatistics	4

Abbreviations: BSPH, bachelor of science in public health; MPH, master of public health.

^a Courses in public health core, health education and promotion core, and MPH core address the foundational competencies required by the Council on Education for Public Health for academic program accreditation.

In step 4, we performed a gap analysis by using methods articulated by Creswell.¹⁷ We, the research team that conducted the mapping, included 4 university faculty members trained in both quantitative and qualitative analysis methods. We became familiar with all DIS job tasks and knowledge competencies, as well as with all core course content. During the gap analysis, 2 researchers performed the coding for job tasks and 2 researchers performed the coding for knowledge competencies. To mitigate the risk of “drifting” (ie, forcing a match between course content and job tasks or knowledge competencies when none existed), each set of researchers discussed and resolved any mapping disagreements. In addition to this iterative comparison process, we also made notes to justify matches, particularly when matching was not straightforward.

The gap analysis included the following elements:

1. Independent mapping: Of the 4 researchers, 2 independently mapped the 56 DIS job tasks by cross-referencing them with BSPH core course content and then separately with MPH core course content. The other 2 researchers independently mapped the 103 DIS knowledge competencies with BSPH core course content and then separately with MPH core course content.

2. Consensus mapping: Each pair of researchers then met and systematically compared their coding of each DIS task and knowledge competency to determine inter-rater agreement. If both researchers agreed on a match between a DIS job task or knowledge competency and course content, it was accepted. If they did not agree, they compared notes and resolved disagreements by discussing the reasoning for the coding (eg, which component of the course syllabus covered the job task or knowledge competency in question). When researchers disagreed, the course instructor resolved the disagreement.

3. Gap identification: The team that had coded the DIS job tasks and the team that had coded the DIS knowledge competencies each grouped its results into 2 categories: job tasks and knowledge competencies aligned with the BSPH or MPH courses and those not aligned with the BSPH or MPH courses, the latter representing the gaps between course content and certain job tasks or knowledge competencies.

In step 5, the research team discussed and assigned to each identified gap 1 or more of 3 recommended strategies used by professional degree programs, each having the potential to improve the alignment between courses and certain job tasks or knowledge competencies. The 3 strategies were elective courses, practicums and experiential learning, and on-the-job training (ie, skills obtained through work experience). We recommended an elective course when alignment could be accomplished by the student taking a guided elective course or by the instructor or college infusing DIS-specific components (ie, online module, lecture, or activity) into the content of a current course in the curriculum. We recommended a practicum when the DIS job task or knowledge competency was too specific for a course and when alignment could be accomplished by the student seeking a practicum site where certain job tasks could be practiced or knowledge competencies could be learned. Finally, we recommended on-the-job training when alignment could be accomplished only by the student becoming a DIS worker and when we considered a course or practicum to be insufficient to achieve alignment.

Results

The health education and promotion BSPH core curriculum contained content that were aligned with 75% (42/56) of all job tasks in the 9 task domains and with 100% of the tasks within domains 2 (investigation activities), 4 (surveillance activities), 8 (case analysis), and 9 (outbreak response and emergency preparedness) (Table 3). The MPH core curriculum contained content or objectives that were aligned with 55% (31/56) of all job tasks and with 100% of the job tasks within domain 9. None of the course content in either curriculum aligned with the job tasks in domain 6 (clinical support services).

Table 3.

Alignment^a of 56 job tasks and 103 knowledge competencies^b for disease intervention specialists (DISs) with BSPH^c and MPH^d core curriculum course content at the Georgia Southern University Jiann-Ping Hsu College of Public Health

DIS Content Domain	DIS Job Tasks, No.			DIS Knowledge Competencies, No.
	Total	Aligneda		Total	Aligneda
		BSPHc	MPHd		BSPHc	MPHd
Domain 1: planning and preparation for case and field work	6	4	4	4	2	2
Domain 2: investigation activities	7	7	3	11	7	6
Domain 3: client encounters and interviewing	16	13	11	27	14	10
Domain 4: surveillance activities	4	4	3	8	5	7
Domain 5: health system collaboration and quality improvement	4	2	3	15	3	6
Domain 6: clinical support services	3	0	0	5	1	1
Domain 7: testing and field services	6	2	1	12	0	5
Domain 8: case analysis	6	6	2	6	4	1
Domain 9: outbreak response and emergency preparedness	4	4	4	4	0	1
Domain 10: cross-functional skills	NA	NA	NA	11	7	3
Total, no. (%)	56 (100)	42 (75)	31 (55)	103 (100)	43 (42)	42 (41)

Abbreviations: BSPH, bachelor of science in public health; CEPH, Council on Education for Public Health; MPH, master of public health; NA, not applicable.

^aAlignment based on matching job tasks and knowledge competencies with course contents of core curricula at a single CEPH-accredited college of public health. Alignment at other programs may vary based on courses offered.

^bJob tasks and knowledge competencies based on Public Health Accreditation Board’s Job Task Analysis and Test Specifications Report.¹³

^cHealth education and promotion BSPH curriculum included a public health core (5 courses) and a health education and promotion core (8 courses).

^dMPH curriculum included 5 courses.

Similarly, the course content and objectives in the health education and promotion BSPH core curricula were aligned with 43% (43/103) and the MPH core curricula with 41% (42/103) of the knowledge competencies in the 10 knowledge domains (Table 3). The course content in the BSPH core curriculum was not aligned with any of the knowledge competencies in domains 7 (testing and field services) or 9 (outbreak response and emergency preparedness).

Job Task Alignment Gaps

The MPH core curriculum content did not align with 25 job tasks, 16 of which were exclusive to the MPH curriculum (Table 4). The health education and promotion BSPH core curriculum content did not align with 14 job tasks, 4 of which were exclusive to the BSPH curriculum. Both the BSPH and MPH core curricula content did not align with another 10 job tasks. Of these 10 tasks, 7 were unique to work done by DISs. Highlights of the recommendations for addressing the gaps in job task alignment included the following:

Table 4.

Disease intervention specialist job tasks^a not aligning^b with core curriculum course contents of BSPH^c and MPH^d programs at a CEPH-accredited college of public health

Domain and Code	Job Taska Not Alignedb	Degree Program Not Alignede	Recommended Strategies for Alignmentf
			Course	Practicum	On-the-Job Training
Domain 1: planning and preparation for case and field work
J1.4g	Maintain field toolkit and supplies (eg, cell phone, client referrals, maps, disease information pamphlets, testing kits, personal protective equipment, condoms)	Both			X
J1.1	Collect and verify relevant client information (eg, demographic, contact, medical history) from medical records/information systems (eg, electronic health records, provider calls)	MPH	X
J1.6	Comply with local field safety plan (eg, notification of schedule and location)	BSPH	X
Domain 2: investigation activities
J2.1	Conduct field investigations to residences or other community locations (eg, park, street corner, homeless shelter) to inform clients of disease exposure or positive test results	MPH	X
J2.2	Use alternative electronic investigation tools (eg, social media, sex-seeking sites and apps, LexisNexis, Department of Motor Vehicles, correctional database)	MPH	X
J2.5	Use alternative third-party investigation methods when an individual cannot be reached (eg, through neighbors, local businesses)	MPH	X
J2.6	Document intervention activities in a timely manner per local protocol (eg, contact method, date and time, individuals encountered, referral specifics, plan of action, testing, adequate treatment)	MPH	X
Domain 3: client encounters and interviewing
J3.13	Collaborate with client to develop and implement a risk-reduction plan	Both	X
J3.1	Identify oneself and one’s role in accordance with local protocol	MPH	X
J3.12	Promote comfortable environment for client communication (eg, establish rapport, cultural competency)	MPH	X
J3.14	Elicit information on venues or social settings where clients may have been exposed to disease (eg, bathhouses, shooting galleries, group living homes, correctional facilities)	MPH	X
J3.15	Negotiate method of partner/contact notification (eg, provider referral, self-referral, contract referral, dual referral)	MPH	X
J3.3	Ensure a confidential environment during client encounters	BSPH	X
J3.4	Notify client of test results, disease exposure, or environmental risk	BSPH			X
Domain 4: surveillance activities
J4.3	Record search communicable disease surveillance systems to identify client laboratory and/or treatment history and determine prioritization for follow-up	MPH	X
Domain 5: health system collaboration and quality improvement
J5.2	Conduct provider/laboratory education and visitation to ensure reporting compliance and awareness	Both	X
J5.4	Contribute to program and health department quality improvement activities (eg, peer reviews, collaborative case conference)	BSPH	X
Domain 6: clinical support services
J6.1g	Verify that client received testing, adequate treatment, and support services as appropriate	Both		X	X
J6.2g	Provide clinic support services (eg, pre- and posttest counseling, point-of-care testing, specimen collection, directly observed therapy [DOT])	Both		X
J6.3	Provide follow-up with client in accordance with Centers for Disease Control and Prevention recommendations (eg, completion of treatment, linkage to care, reengagement in care)	Both	X
Domain 7: testing and field services
J7.1g	Collect and transport specimens (eg, venipuncture [blood], sputum, urine, extragenital swabbing)	Both		X	X
J7.2g	Administer off-site testing and deliver results (eg, purified protein derivative/tuberculin skin test, rapid HIV, syphilis, hepatitis C)	Both		X	X
J7.3g	Deliver and observe treatment (eg, DOT, expedited partner therapy, field-delivered therapy) in nonclinical settings to ensure adherence	Both		X	X
J7.4g	Serve public health orders to clients in the field per jurisdiction protocol (eg, isolation, sexually transmitted disease/HIV cease and desist)	Both		X	X
J7.6	Identify and respond appropriately to unsafe situations (eg, body language, threat of bodily harm, environmental cues)	MPH	X
Domain 8: case analysis
J8.2	Determine interview objectives (eg, information to be elicited, education to be accomplished)	MPH	X
J8.3	Review available case information to determine case priority level or disease staging classification	MPH	X
J8.5	Conduct subsequent client interview to document progress and collect additional information as needed	MPH	X
J8.6	Conduct case analysis to determine additional steps for intervention (eg, visual case analysis, ghosting, source spread analysis, analysis of genotypes, environmental transmission factors, prioritizing contact investigation, evaluating case for completion)	MPH	X
Domain 9: outbreak response and emergency preparedness
NAh	NAh	NAh

Abbreviations: BSPH, bachelor of science in public health; MPH, master of public health; NA, not applicable.

^aJob tasks based on Public Health Accreditation Board’s Job Task Analysis and Test Specifications Report.¹³

^bAlignment based on matching job tasks with course contents of core curricula at a single Council on Education for Public Health (CEPH)–accredited college of public health. Alignment at other programs may vary based on courses offered.

^cHealth education and promotion BSPH curriculum included a public health core (5 courses) and a health education and promotion core (8 courses).

^dMPH core curriculum included 5 courses.

^eJob tasks not aligning with BSPH curriculum courses labeled BSPH, those not aligning with MPH core curriculum courses labeled MPH, and those not aligning with both labeled both.

^fThe 3 recommended strategies with potential to improve alignment between curriculum content and certain job tasks were: elective courses or adjustments to courses, practicums and experiential learning, and on-the-job training (skills obtained through work experience).

^gJob tasks unique to work performed by disease intervention specialists.

^hDomain 9 was fully aligned.

1. Elective courses or course adjustments could align the MPH curriculum with 18 additional job tasks and the BSPH curriculum with 6 additional job tasks.

2. Practicums (or experiential learning) could align the BSPH and MPH curricula with job task J6.2 (providing clinic support services).

3. Tailored practicums specific to student desire to train as a DIS, or on-the-job training as a DIS, could align the BSPH or MPH curricula with 8 job tasks unique to DIS work.

Knowledge Competency Alignment Gaps

The MPH core and BSPH health education and promotion core curricula content had similar proportions of alignment with knowledge competencies (Table 5). The MPH curriculum did not align with 61 knowledge competencies, 23 of which were exclusive to the MPH curriculum. The BSPH curriculum content did not align with 60 knowledge competencies, 22 of which were exclusive to the BSPH curriculum. Both the BSPH and MPH core curricula content did not align with another 38 knowledge competencies. Of these, 9 were unique to work performed by DISs. Highlights of the recommendations for addressing the gaps in knowledge competency alignment included the following:

Table 5.

Disease intervention specialist knowledge competencies^a not aligning^b with core curriculum course contents of BSPH^c and MPH^d programs at a CEPH-accredited college of public health

Domain and Code	Knowledge Competenciesa Not Alignedb	Degree Program Not Alignede	Recommended Strategies for Alignmentf
			Course	Practicum	On-the-Job Training
Domain 1: planning and preparation for case and field work
K1.1	Gathering information from medical records (abstraction)	Both	X
K1.3	Work efficiencies (eg, multitasking, time management, prioritization, organization)	MPH	X
K1.2	Navigational tools (eg, reading printed maps, mobile application mapping tools)	BSPH	X
Domain 2: investigation activities
K2.9	People search engines (eg, LexisNexis, Google, Facebook)	Both	X
K2.10	Programmatic investigative requirements (eg, how many field visits required, how many attempts to make, when to expand case, when to close case)	Both	X
K2.4	Documentation standards (eg, field work progress)	MPH	X
K2.5	Electronic instant communication applications (eg, instant messaging, texting)	MPH	X
K2.8	Neighborhood characteristics	MPH	X
K2.1	Contact investigation/partner notification protocols	BSPH	X
K2.11	Testing technologies and interpretation (eg, sensitivity, specificity, causes of biologic false positives)	BSPH	X
Domain 3: client encounters and interviewing
K3.1	Adverse side effects of treatment	Both	X
K3.6	Conflict management and resolution	Both	X
K3.13g	Interpretative services	Both			X
K3.14	Interview techniques	Both	X
K3.15	Laboratory test counseling	Both	X
K3.17	Negotiation techniques	Both	X
K3.21	Motivating clients	Both	X
K3.22	Posttest counseling skills	Both	X
K3.23g	Referral methods (eg, provider referral, self-referral, dual referral)	Both			X
K3.2	Area resources and support services (eg, hospitals, community-based organizations, mental health facilities, rehabilitation centers, housing, employment)	MPH	X
K3.3	Barrier identification and resolution	MPH	X
K3.4	Client-centered counseling	MPH	X
K3.18	Nonjudgmental approach	MPH	X
K3.19	Nonverbal communication	MPH	X
K3.20	Open-ended questions	MPH	X
K3.25	Risk of transmission/acquisition	MPH	X
K3.27	Survey administration	MPH	X
K3.5	Communicable disease characteristics (eg, etiology, signs and symptoms, transmission, incubation period, infectious period, disease staging, source spread)	BSPH	X
K3.7	Confrontation techniques (eg, polite prompt, creating dissonance, presenting conflicting information)	BSPH	X
K3.8	Conveying test results	BSPH	X
K3.9	Elicitation (eg, history, sexual encounters, environmental characteristics, drug use, demographic characteristics, clusters, contacts)	BSPH	X
Domain 4: surveillance activities
K4.6g	Out-of-jurisdiction practices and process	Both			X
K4.1	Data collection and entry	BSPH	X
K4.3	Disease case management applications and databases (eg, surveillance registries, electronic health records)	BSPH	X
Domain 5: health system collaboration and quality improvement
K5.1g	Available medical providers	Both			X
K5.7	Laboratory operational procedures	Both	X
K5.8g	Local high-volume providers	Both			X
K5.11g	Other testing sites (eg, blood banks, plasma centers)	Both			X
K5.12	Quality improvement fundamentals	Both	X
K5.13	Quality improvement plan	Both	X
K5.2	Community partners/stakeholders	MPH	X
K5.3	Establishing and maintaining collaborative relationships	MPH	X
K5.4	Health department vision/mission	MPH	X
K5.5	Health care systems	BSPH	X
K5.6	Jurisdictional statutes and regulations for disease control	BSPH	X
K5.9	Local memorandum of understanding and policies	BSPH	X
K5.10	Local public health program plan, requirements, policies, and procedures	BSPH	X
K5.14	Privacy practices and reporting requirements (eg, disease, abuse, trafficking)	BSPH	X
K5.15	Third-party communication (eg, talking to neighbors, family members)	BSPH	X
Domain 6: clinical support services
K6.2	Communicable disease treatment guidelines and standing orders	Both	X
K6.3g	Linkage-to-care guidelines and procedures	Both			X
K6.5	Navigation of health care services (eg, linkage to care)	Both	X		X
K6.4	Medical terminology	MPH	X
K6.1	Clinic policy and procedure	BSPH	X
Domain 7: testing and field services
K7.1	Delivery of medication	Both		X
K7.2	Employee exposure procedures (eg, occupational postexposure prophylaxis for HIV, tuberculosis)	Both	X
K7.6g	Off-site testing procedures	Both			X
K7.8	Rapid test technology and interpretation	Both		X
K7.9	Specimen collection, handling, and processing (eg, venipuncture, sputum, urine, swabbing)	Both	X	X
K7.10	Test readiness assessment (eg, HIV test)	Both		X
K7.12g	Workload prioritization consistent with program objectives and performance standards	Both			X
K7.3	Field safety protocols	BSPH	X
K7.4	Field testing protocols	BSPH	X
K7.5	Local safety protocols	BSPH	X
K7.7	Personal protective equipment	BSPH	X
K7.11	Translation and interpretation of data for further development of program	BSPH	X
Domain 8: case analysis
K8.5	Required case investigation and management data	Both	X
K8.6	Resolving data inconsistencies	Both	X
K8.1	Analysis of interview information	MPH	X
K8.2	Available case and location analysis tools	MPH	X
K8.3	Case management	MPH	X
Domain 9: outbreak response and emergency preparedness
K9.2	Incident command structure	Both	X
K9.3	Isolation and quarantine procedures	Both	X
K9.4	Outbreak response plan and individual role	Both	X
K9.1	Environmental assessment	BSPH	X
Domain 10: cross-functional skills
K10.8	Problem solving	Both	X
K10.9	Reflective listening	Both	X
K10.10	Situational awareness	Both	X
K10.11	Standard operating procedures	Both	X		X
K10.1	Active listening	MPH	X
K10.2	Adaptability to changing environment	MPH	X
K10.3	Communication techniques	MPH	X
K10.7	Health literacy	MPH	X

Abbreviations: BSPH, bachelor of science in public health; CEPH, Council on Education for Public Health; MPH, master of public health.

^aKnowledge competencies based on Public Health Accreditation Board Job Task Analysis and Test Specifications Report.¹³

^bAlignment based on matching knowledge competencies with course contents of core curricula at a single CEPH–accredited college of public health. Alignment at other programs may vary based on courses offered.

^cHealth education and promotion BSPH curriculum included a public health core (5 courses) and a health education and promotion core (8 courses).

^dMPH curriculum included 5 courses.

^eKnowledge competencies not aligning with BSPH core curriculum courses labeled BSPH, those not aligning with MPH core curriculum courses labeled MPH, and those not aligning with both labeled both.

^fThe 3 recommended strategies having potential to improve alignment between curriculum content and certain knowledge competencies were: elective courses or adjustments to courses, practicums and experiential learning, and on-the-job training (skills obtained by work experience).

^gKnowledge competencies unique to work performed by disease intervention specialists.

1. Elective courses or course adjustments could align the MPH curriculum with 49 additional knowledge competencies and the BSPH curriculum with 48 additional knowledge competencies.

2. Practicums could align both the MPH and BSPH curricula with 3 additional knowledge competencies: K7.1 (delivery of medication), K7.8 (rapid test technology and interpretation), and K7.10 (test readiness assessment).

3. Either elective courses or practicums could align both the MPH and BSPH curricula with knowledge competency K7.9 (specimen collection, handling, and processing).

4. On-the-job training as a DIS could align the BSPH or MPH curricula with the 9 knowledge competencies unique to DIS work.

5. Elective courses, practicums, or on-the-job training could improve alignment of the BSPH and MPH curricula with knowledge competencies K6.5 (navigation of health services), K7.9 (specimen collection, handling, and processing), and K10.11 (standard operating procedures). Whereas elective courses would be most likely to improve knowledge competency related to these items, practicums or on-the-job training would be more likely to improve actual skills.

Discussion

Our findings suggest a considerable degree of alignment between existing CEPH-affiliated public health educational core curricula and the job tasks and knowledge competencies required for robust DIS workforce training. However, our gap analysis also identified job tasks and knowledge competencies that need to be addressed in DIS workforce training but were not covered by the courses composing both the BSPH and the MPH core curricula. These gaps in DIS training represent potentially actionable information that may guide future public health education and training strategy and policy.

To begin with, public health academic administrators need to increase awareness within their programs of the importance of skills and knowledge specific to DIS job performance and how these might be more effectively incorporated into their training programs. This awareness should also be promoted at the affiliated public health credentialing, governing, and organizational levels. The CEPH might seek to develop an optional accreditation module for programs of public health wishing to meet a curriculum standard whereby graduates can become DIS-certified. The development of standardized nondegree certificate programs for DISs could also be offered by academic training programs. A standardized DIS curriculum model that provides a sample scope and sequence of courses and that can be replicated across public health training programs nationwide would be particularly beneficial. This curriculum should be clearly defined by a comprehensive set of evidence-based DIS workforce-specific learning objectives. It should use a clearly defined learner assessment approach, in which practice-based exercises and/or assignments would be integrated within learning environments, and assessment and evaluation strategies would include continuous quality improvement feedback cycles and be linked to the articulated competencies and learning objectives. Finally, this curriculum should be offered asynchronously or through appropriate distance-learning modalities, to maximize its reach to the intended workforce audience.

A potential barrier to meaningful change in the area of DIS training exists within the public health practice community. The general public health workforce is already stretched thin, as members seek to meet the 3 core functions of public health (assessment, policy development, and assurance).¹⁸ Furthermore, as noted in the Public Health Accreditation Board’s Job Task Analysis Report, a substantial proportion of the current DIS workforce does not hold even a bachelor’s degree in public health.⁸ Because of these potential barriers, the goal of meeting DIS workforce needs might be aided by promoting DIS-specific competencies through certificate or practice-based training programs.¹⁹ Hence, a multidimensional approach will be necessary, providing DIS workforce training and professional development to current public health workers, while at the same time seeking to infuse DIS-specific curricula into the nation’s academic public health training programs.

Another challenge to bringing about change in DIS workforce development involves the difficulty of both identifying and operationalizing strategies that are likely to facilitate the desired change.^20,21 Our findings suggest ways in which DIS workforce quality can be improved in academic public health training programs. Indeed, accredited academic public health programs are well positioned to serve the educational needs of students at the bachelor and master levels. These programs regularly evaluate and assess their curricula, and as a result, new training activities and curricula are being introduced.²² In addition, key national professional organizations, including the Centers for Disease Control and Prevention, the Public Health Accreditation Board, the National Association of County and City Health Officials, and the National Coalition of STD Directors, are investing resources in evaluating and promoting the development of the DIS workforce.²³ Local public health departments are also central to developing and engaging the DIS workforce, because this represents the workforce intersection with the community.

Ultimately, however, it is up to the public health practice community to implement changes in practice. Intentional, effective, and complete engagement by the practice community is necessary to strengthen the nation’s DIS workforce. Local health departments have a substantial DIS workforce already in place, with more than 2060 DISs nationwide. Efforts to reach out to local health department leaders with regard to DIS workforce development initiatives will be essential in promoting the uptake of DIS workforce standardization and quality improvement. The academic public health community will be unable to bring about the needed changes without the full support of those working on the front lines in local health departments. Strengthening the DIS workforce is more likely to be possible and sustainable with a public health practice–based commitment toward DIS workforce development.

Limitations

This gap analysis had several limitations. First, our findings were based on programs at 1 CEPH-accredited college of public health and, as such, may not be generalizable to all public health academic programs in the United States. The extent to which DIS-related job tasks and knowledge competencies were explored within individual academic public health programs may vary. Whereas some programs may offer courses that provide in-depth focus on the skills and knowledge directly related to DIS job performance, other programs may offer only a cursory examination of these items and provide a broad overview of the concepts, skills, and competencies needed in public health practice.

Conclusions

DISs currently arrive in their roles in public health practice from various educational and experiential backgrounds. Our findings suggest that BSPH and MPH core curricula at formal public health academic programs may not be fully aligned with the job skills and knowledge competencies needed by DISs to function at their full potential. Investigation into the alignment of job skills and knowledge competencies with core courses at other schools and programs of public health is warranted. Strategic core course adjustments or additions of elective courses, based on gap analyses, may be one way programs can improve alignment and provide a more solid educational foundation for the DIS workforce.