Health Care Reform Advocacy Options: Reaching Consensus Among Health Professionals

Background/Purpose: The American health care system is currently in a state of transformation, and the health education profession has an opportunity increase involvement in health care activities to positively influence population health.  The primary purpose of this study was to prioritize recommendations from health educators for health care reform in relation to the different levels of the determinants of health ecological model (initial recommendations were gathered in a previous qualitative study).  

Method: This study utilized a Delphi technique in which a group of health educators prioritized recommendations for health care reform in an attempt to reach consensus.  A listserv of CHES and MCHES health educators was purchased, and once participants were solicited and selected, they were asked to rank order the recommendations and provide a rationale for their rankings.  After participants ranked the recommendations, measures of central tendency (mean, median, and mode) and level of dispersion (inter-quartile range and standard deviation) were calculated to gather information regarding collective judgments of respondents.  The recommendations were placed in rank order and results were shown to participants in subsequent questionnaires in order to facilitate the process of consensus.  This process was repeated two times in an attempt to find the top five priorities remaining stable over two separate solicitations. 

Analysis/Results: Forty-nine participants completed the first questionnaire, 40 completed the second questionnaire, and 29 completed the third and final questionnaire.  While it was hoped that the questionnaires would elicit consensus among participants, Kendall’s W, or Kendall’s Coefficient of Concordance, illustrated the opposite trend and yielded indeterminate results showing little to no agreement regarding recommendations for health care reform and roles for health educators in light of recommendations made.  Despite lack of consensus, the following recommendations had mean rankings over 8.0 out of 10.0 and were ranked by over 85% of participants:

Chronic disease self-management programs

Health insurance reimbursement for those practicing prevention (including health educators)

More health education in K-12 schools

Prevention education at all doctors’ visits

Conclusions: While the small sample of this study does not elicit results that can be said to be representative of the entire health education profession, these results do represent a basis or starting point from which to develop further research and policy or advocacy initiatives.  Sharing these recommendations with the health education profession is essential to development of health care advocacy initiatives and can bring together groups of health educators with similar priorities.