Results of a Delphi study: public health education in the year 2010
Martha Milk, University of Minnesota
This study used a combination of ethnographic futures interviews and the Delphi technique to ask a selected group of American public health leaders about their views on the future of health education. The purpose of this study was to demonstrate a model for proactive planning through participants views on changing roles, trends, future issues of concern and future methods of educating the public.
A review of health education and futures research literature
The following literature review introduces the reader to the purpose of futures research and then provides a description of the method used for this study. Since this study is a future study related to health education, the literature review also provides a brief description of health education as well as a description of how it has changed over the past few decades. The main purpose for providing this review of the literature is to demonstrate that other writers see the changes in society and how they are impacting on the profession and these writers also see that new directions are needed.
Introduction to the study of the future
Futures research, Enzer stated, is concerned with understanding long-term social conditions, their prospects for change, and the direct or indirect consequences of these changes. Enzer believed that futures research is concerned with the study of alternative futures, not with predicting what will occur.
Toffler explained that the ultimate purpose of introducing futurism into education is not to create images of the future, but to help learners cope with real-life crisis - to strengthen the individual’s ability to anticipate and adapt to change. Toffler argued that in a fast-shifting environment individuals must know more than how to receive and sort data, they must have the opportunity to make change or to fail in the attempt. Toffler felt that it is a prime task of education to help make individuals more sensitively responsive to change.
The Delphi as a method of futures research
Hill and Fowles stated that virtually all futurists and a surprising number from the public-at-large recognise the Delphi technique to be a laudable attempt to systematise what has traditionally been unsystematic and haphazard and so to meet the ever-growing need to anticipate the future. Hill and Fowles described the Delphi method as a procedure for polling a panel of respondents concerning the likelihood and probable date of occurrence of supposedly future events. The respondents are mutually anonymous and are questioned over several rounds by mail.
Delphi studies in health and education
Sullivan and Brye conducted a Delphi study to predict future trends and roles in nursing. They concluded from their study that the Delphi has considerable use in curriculum planning. Carlaw et al. conducted a Delphi study on the future directions and manpower needs of eight states in the upper Midwest for the year 1990. The principal purpose of their study was to obtain a profile of the knowledge and skills required to address major public health issues in the future. Rossman and Bunning conducted a Delphi study to assess the knowledge and skills which will be needed in the future by adult educators. They included 141 university professors of adult education in their study. They saw four unique merits to using the Delphi. (1) It avoids specious persuasion, leadership influences and hidden agendas; (2) it allows a variety of individuals to participate equally, even though widely separated by geography; (3) several studies have shown that the Delphi has remarkable accuracy; (4) it provides a documentation of a precise nature which includes minority opinions.
Definition and history of health education
The Thirty-sixth World Health-Assembly in 1983, defined health education as any combination of information and education activities leading to a situation where people want to be healthy; know how to attain health; do what they can individually and collectively to maintain health, and seek help when needed.
An evolution of health education policies as articulated by the World Health Assembly over the past 30 years has shifted the emphasis from central to local planning; from singular (specific disease) to diverse objectives; from building health literacy and skills in support of specific programmes to promoting a holistic educational approach to problems; from focusing on individual behaviour change to a concern for organisational, economic and environmental factors conducive to healthy lifestyles, self-reliance and political action for health promotion.
Robinson and Alles commented on the role of health education throughout history. They stated that health education could be criticised for being reactionary: that is for providing education in areas after problems have been identified. But, health education has consistently attempted to meet the pressing health and social needs of the nation and individual communities.
Changing directions for public health education.
Breckon, Harvey and Lancaster asked where the profession of health education is going. They believed that there will be increasing roles for the health education professional. They envisioned an increase of entry level skills and an expansion of health education in many settings. They believed that more health care and health education will be delivered in homes and in ambulatory care centres; that technology will increase and in fact provide a base for a resurgence of health education in schools; and that there will be new formats for health education to expand and flourish.
St. Pierre and Shute believed that how well the profession adapts to future needs will dictate the future of health education. They believed it important for health educators who are entering the field to develop an interest in the study of the future so that they will be better prepared to serve their clientele and to exert some control over the present.
Method of investigation
This study combined two methods of data gathering ethnographic futures research (EFR) and mailed Delphi rounds. In this study these two methods are modified and combined to form the Ethnographic Futures Delphi. In an Ethnographic Futures Delphi the EFR interview is used as round one of the Delphi. The responses from the interviews are categorised and summarised according to the probe topics and then used to develop the multiple choice responses for the mailed Delphi questionnaires.
The panellists in a Delphi study are typically chosen for their recognised expertise in the field. The seventy-seven panellist’s of this study were chosen because of their leadership in national public health organisations or public health related organisations or because they were referred by national leaders. Participation in this study was by invitation.
Twenty-seven panellists agreed to participate in the entire study. (See table below for actual participation rate). Another fifty persons agreed to take part only in the mailed questionnaire portion of the study.
*All questionnaires have not been returned as of this date
In the first round those interviewed discussed their most optimistic, pessimistic and most probable views of the future in relation to public health, health education and the continuing education needs of health education providers for the year 2010. Following is a summary of the trends related to health education which they indicated supported their optimistic, pessimistic and most probable scenarios.
Health Education (optimistic):
- many of the programs in this country are heading towards health promotion, in schools of medicine and schools of public health greater emphasis is being placed on health promotion
- too much emphasis is placed on individual behaviour to the exclusion of environmental controls and the organisation of the health care delivery system in the last ten years we’ve actually seen some success in the area of behavioural health or health promotion
- there has also been a trend in health education research to assess the effectiveness of health education programmes in a number of different areas.
Health Education Direction (pessimistic):
- the voluntary agencies are going to continue to develop campaigns geared to the people who give them money and to those segments of the population that they think they’re going to get the most change; and the hard to reach will still be hard to reach because we are going headlong into the future geared in all of our public health notions toward middle America;
- AAHE is proposing an international credo for health education focused on individual behaviour, this whole thing on individual behaviour is like blaming the victim, the whole emphasis now is on individual behaviour;
- there is a trend toward trivialising the teaching of adolescent social skills; there is a trend to mass media everything rather than work on actual skill development, this trend relates to the tendency in our culture to oversimplify.
Health Education (most probable):
- we’re seeing people in all sectors providing health education services; health education is becoming more commercially based;
- the federal government has recently made a fairly strong commitment to health education of kids, mostly through the schools;
- health educators are taking separate routes in how they relate to people, some want to empower people with new skills or with taking charge of their own lives, and there are others who want to legislate and mandate;
- roles are changing, more people will be doing health education and the health educators role will become more specific, we are seeing the beginning of the need for all professions to be doing health education and health educators are needing to be there as resource people to those other professionals.
Existence of a profession in 2010
In the second round of the Delphi participants express their views on the existence of a health education profession in 2010 and responded in the following way:
25% - there will be a profession, but it will be very different,
54% - there will be a profession but it will change somewhat,
12% - there will be a profession but it will be pretty much the same as it is now.
Roles and functions
Participants in Round 2 also responded to questions on the likelihood and desirability of several roles for health education. The chart below demonstrates the relationship between participants’ hopes and desires about the future and their belief in the likelihood of occurrence of each of the options. The scales used on the questionnaire were from 1-5 with 1 highly desirable and 5 highly undesirable on the Desirability scale and on the Likelihood scale I was virtually certain and 5 virtually unlikely.
As you can see the participants found most of the items to be both desirable and certain and ranked most on the positive end of the scale.
Significance of study
This study offers some new alternatives to old practices. The study challenges professionals in the field of public health, health education and adult and continuing education to see the new possibilities, to consider alternative ways of doing things and to face tomorrow prepared for its challenges.
This study demonstrates a process which can be used for proactive planning. The model is not meant to be used in isolation but rather as a part of a planning process in which the Ethnographic Delphi Technique is used as a tool for eliciting views of the future.
This study represents the thinking of leaders in the field of public health. Participants were not a random sample of the field. They represent themselves and their responses are indicative of what they, as one group of public health leaders, feel about the future of health education as it relates to the total field of public health. The results of this study are but one alternative scenario in the array of possible options. In planning programmes this method can be utilised again and again. It is the hope of the author that the results of this study will be considered as future alternatives, that the desires and interest of these public health leaders will be analysed and evaluated, and that this study and the ideas expressed in it will engender further study on the future of the profession.
 Enzer, S. (1983) New directions in futures methodology. In New Directions for Institutional Research, 39, 69-84