An Online Graduate Certificate Program

Ethnic & Rural Health Disparities (ERHD)

Graduate Certificate Online Program

Statement of Need for Proposed Program and Basis for Need at ECU

We are submitting our proposal for a new graduate certificate program entitled, “Ethnic and Rural Health Disparities (ERHD) Graduate Certificate Online Program” in response to a curriculum void and a need to address ethnic and rural health disparities issues in the Brody School of Medicine and the Department of Public Health at East Carolina University (ECU).

ECU is located in Greenville, North Carolina (NC). Greenville, NC and ECU have a geographic location and history that promotes a strong culture of service to eastern North Carolina and throughout the state. This community service culture challenges the institution to continuously strive to meet the area’s employment needs in the growing service, construction, manufacturing, agriculture, education, and healthcare industries. In addition to the regional economy, ECU is also growing in the number of students that it serves on a state, national, and international level. The institution, currently at approximately 27,500 students, will continue to grow in its capacity to accommodate students entering the University of North Carolina (UNC) system. ECU also has a reputation for strong programs in distance education and was named by the UNC system as a leader in distance education. ECU is currently experiencing tremendous growth in its capacity to serve the region, state, and national needs. The institution is flourishing with growing faculty expansion and an administration and faculty striving for excellence in teaching, research, and service.

One of the major pedagogical challenges related to ethnic health and rural health disparities is how to teach this topic to health professionals and public health administrators who may be new to health disparities as a field of research and public health service. One new approach is to use the online, distance education infrastructure within ECU and the 16 campus UNC system to reach the rural, underserved health disparity communities of eastern North Carolina. With the success of our current set of online ethnic health and health disparity-related courses in the Department of Public Health, we identified a need to develop an online graduate certificate program in Ethnic and Rural Health Disparities at ECU’s Brody School of Medicine.

This proposed certificate program is high priority among faculty in the Department of Public Health, Brody School of Medicine, and upper administration at ECU. This is demonstrated in the planning of this project. The Dean and Vice Dean for Academic Affairs in the Brody School of Medicine and Chairperson for the Department of Public Health have all been involved in project planning and have committed matching time to this project as they feel it is an incredibly valuable endeavor. The project is strongly linked to and supports ECU’s practice-based program Master of Public Health Program which is specifically tailored to individuals working in public health, medicine, and health or health-related agencies without formal training in public health.

The three major objectives for the certificate program are to get graduates to: (1) identify ethnic and rural health disparities issues; (2) analyze more comprehensively ethnic and rural health disparities issues; and (3) develop more culturally competent projects, plans and policies that are designed for specific ethnic and rural communities in NC, the United States and communities around the world.

The Department of Public Health is within the Brody School of Medicine. The Brody School of Medicine provides accredited education programs for medical students, residents and fellow, doctoral students in the basic medical sciences, and practicing physicians. The hallmarks of these programs are close-faculty student interaction, experiential learning, and development of students’ ability to continue learning even after they leave the formal educational setting. Our education programs are consistent with our missions of enhancing generalist training and offering opportunities in medicine to minority and disadvantaged students.

The Master of Public Health degree program in the Department of Public Health admitted its inaugural class in fall 2003. This interdisciplinary program prepares professionals to provide public health leadership in a variety of health and human service settings. Consistent with the regional characteristics of eastern North Carolina, ECU’s MPH degree focuses on public health needs of rural and minority populations. Full-time students can complete the 45-semester hour curriculum in two years. Courses are being taught in the late afternoon or evening to encourage individuals already working in the health field to upgrade their education. Part-time students can take up to four years to complete their MPH degree. The core curriculum, consistent with accreditation requirements of the Council on Education for Public Health, integrates the applied and theoretical foundations of public health with those of medicine and other health-related disciplines. Our MPH program received National Accreditation in June 2007 from the Council on Education for Public Health (CEPH).

In the state of North Carolina, the 2006 Report Card on Racial and Ethnic Health Disparities in North Carolina conducted by the Office of Minority Health and Health Disparities and the State Center for Health Disparities reported the following ethnic and rural health disparity trends:

HIV disease deaths per 100,000 population for African Americans was 20.5; Hispanic/Latino 3.6, American Indian 2.9, White 1.5, and Asian/Pacific Islander 0.6.
Prostate cancer deaths per 100,000 male population for African Americans were 73.0, American Indian 37.2, White 25.1.
Lung cancer deaths per 100,000 population for Whites 60.3, African American 59.8, American Indian 48.1, Asian/Pacific Islander 21.3, and Hispanic/Latino 19.9.
Breast cancer deaths per 100,000 female population for African Americans were 33.3, American Indian 23.7, White 23.5, Hispanic/Latino 11.6, and Asian/Pacific Islander 9.2.
Percent of High School Students who smoked cigarettes on one or more of the past 30 days for Whites was 29.0, Hispanic/Latino 17.4, and African Americans 17.3.
Suicide deaths per 100,000 population for Whites 13.5, Asian/Pacific Islander 6.1, American Indian 5.9, African American 5.5, and Hispanic/Latino 4.5.

The combination of these ethnic and rural health disparity data from a state and national perspective indicates that there is much to learn on all levels of higher education about the ongoing health disparity crisis in our state and nation. This is precisely the reason why there is a urgent need to assist our public health professionals in a new way through online, distance education to learn specific public health skills sets that will assist them in working better with ethnic and rural health disparity populations.

Statement of Educational Objectives & Proposed Course Sequence

The proposed new graduate online Certificate Program in Ethnic and Rural Health Disparities is designed to use the online, distance education infrastructure within ECU and the UNC 16 campus system to prepare public health graduate students in specific areas of ethnic and rural health disparities.

This proposed graduate online Certificate Program in Ethnic and Rural Health Disparities has three major objectives.

(1) Identify ethnic and rural health disparities issues;

(2) Analyze more comprehensively ethnic and rural health disparities issues; and

(3) Develop more culturally competent projects, plans and policies that are

designed for specific ethnic and rural communities in the United States and

global communities around the world.

Objective 1 is to identify ethnic and rural health disparities. This objective will be achieved by offering the following four online courses:

MPH 6005 African American Health
MPH 6007 Global Public Health
MPH 6008 Ethnic Health and Health Disparities
MPH 6009 Capstone Experience in Ethnic Health & Health

Disparities

Three of the online courses (MPH 6005, MPH 6007, and MPH 6008) have been successfully taught by Dr. Eric Bailey for the past three years and MPH 6009 will be team taught with Dr. Justin Moore of the Department of Public Health.

Upon completion of each of the four online courses, students will fulfill the following six major MPH core competencies:

Describe the role of social and community factors in both the onset and solution of public health problems.
Identify individual, organizational, and community concerns, assets, resources and deficits for social and behavioral science interventions.
Use evidence-based approaches in the development and evaluation of social and behavioral science interventions.
Describe steps and procedures for the planning, implementation and evaluation of public health programs, policies, and interventions.
Demonstrate sensitivity to varied cultural, ethnic, and socioeconomic backgrounds of individuals and groups, including education, health, literacy, race, gender, ages, profession, political preferences, health conditions, religion/spirituality, place of origin, sexual orientation and lifestyle.
Recognize the varied levels of health access among individuals and within communities.

Course descriptions are as follows:

MPH 6005 African American Health – Comprehensive, holistic, and sociocultural perspective focusing on national, regional, state, county and local African-American health and health disparity issues leading toward developing public health interventions.
MPH 6007 Global Public Health – Explores the issues related to the fields of medical anthropology and public health leading toward developing global health interventions.
MPH 6008 Ethnic Health and Health Disparities – Explores the issues related to ethnic health and health disparities, leading toward developing new public health intervention programs.

MPH 6009 Capstone Experience in Ethnic Health and Health Disparities – Integrates critical thinking concepts, research strategies, public health skills, and culturally competent training culminating in a final project. Final project will be evaluated by the Ethnic Health and Health Disparities Capstone Faculty Committee (This course has already been reviewed by the Graduate Curriculum Committee in January 2009).

CERTIFICATE PROGRAM COURSES

Course Number	Credit Hours	Course Title
MPH 6005	3	African American Health
MPH 6007	3	Global Public Health
MPH 6008	3	Ethnic Health and Health Disparities
MPH 6009	3	Capstone Experience in Ethnic Health & Health Disparities
Graduate Hours	12 TOTAL C.H.s	CERTIFICATE

Objective 2 is to analyze more comprehensively ethnic and rural health disparities issues.

This objective will be achieved when students complete the following three online courses:

MPH 6005 African American Health

MPH 6008 Ethnic Health and Health Disparities
MPH 6009 Capstone Experience in Ethnic Health & Health

Disparities

For each course, students are not only required to complete the extensive testing course work but they also complete an applied medical anthropological, public health fieldwork project. These projects are designed to investigate some particular aspect of ethnic and rural health disparities and also to develop culturally competent solutions.

Objective 3 is to develop more culturally competent projects, plans and policies that are designed for specific ethnic and rural communities in NC, the United States and communities around the world. This objective will be achieved when students complete each of the certificate online courses:

MPH 6005 African American Health
MPH 6007 Global Public Health
MPH 6008 Ethnic Health & Health Disparities
MPH 6009 Capstone Experience in Ethnic Health & Health

Disparities

The anticipated outcomes of this ERHD Graduate Certificate Online program is to graduate new public health professionals from various professional and ethnic backgrounds who will have acquired a new set of public health skills designed to be more culturally competent in the field of public health and to be more culturally competent in ethnic and rural health disparities. These four online courses are designed to achieve this objective.

Timeline and Milestones

Timetable

	Fall 2009	Spring 2010	Summer 2010	Fall 2010	Spring 2011	Summer 2011	Fall 2011
Submit Final Course to Curriculum Committee: Capstone Experience in Ethnic Health & Health Disparities: MPH 6009	X
Teach MPH 6007: Global Public Health	X			X			X
Teach MPH 6008: Ethnic Health & Health Disparities		X			X
Teach MPH 6005: African American Health			X			X
Teach MPH 6009: Capstone				X			X
Graduates of Certificate Program				X			X
Promote Certificate Program at APHA Conference				X			X
Conduct Cultural Competency Assessment		X		X			X

Statement of Admission and Retention Standards for Completion of Certificate

To be admitted, all applicants must send their materials to the Admission Committee and the Graduate School. Once the Graduate School admits the student, the student will receive a letter to enroll in the Certificate classes. The admissions requirements for non-degree seeking students in the certificate program are different from degree seeking students in the MPH program of the Department of Public Health. Degree seeking students in the MPH program requires students to meet the minimum admission requirements for graduate study by the university and the Master of Public Health program whereas non degree seeking students must meet the minimum admission requirements for graduate study by the university and the ERHD program.

Admissions committee consists of the Director, Co-Director of the ERHD program and another faculty member of the Department of Public Health. The materials from each applicant must include:

An official transcript from every college or university the student completed seven or more s.c.h. of coursework.
An acceptable score on the Graduate Record Examination (GRE).
A resume or curriculum vitae.
A short essay (less than 600 words) explaining why the applicant wants to pursue a Certificate and how her/his future career goals are related to this specialized certificate degree.
An interview is not required for admissions but may be requested at the discretion of the Director.

Applicants must also meet ECU’s admission requirements: an earned baccalaureate degree or its equivalent from an accredited college or university with a grade point average of 2.5 or above and acceptable scores on an approved standardized exam. Completion of the certificate requires completion of approved coursework with an overall grade point average of 3.0 (B). A student may earn only 3 semester hours of credit at a C level. This certificate program is entirely online and no face-to-face meetings will be required. Under normal circumstances, students should be able to complete the certificate program in 18 months or 72 weeks. Completion of the Certificate program can also be a pathway for students to earn a Master’s of Public Health from the Department of Public Health at East Carolina University.

Acceptance into the ERHD Graduate Certificate Online Program will be first determined by ECU’s Graduate School. The student must apply to the Graduate School through the online application system and be admitted by the Graduate School. Once approved and admitted to the Graduate School, the ERHD Admissions committee will review potential applicants to the certificate program. The criteria for acceptance into the ERHD Graduate Certificate Online Program will be determined by the admissions committee on evaluation of the applicant’s record of scholarship, standardized test scores, professional experience and accomplishments, the required essay, and personal interview (if one is required). If the student fulfills the qualifications, the ERHD Admissions committee will recommend to ECU’s Graduate School that the ERHD program would like the student to be admitted.

The Certificate program will be committed to equality of opportunity and will not discriminate against applicants or students based on race, religion, color, creed, national origin, sex, age, sexual orientation, or disability. We intend to work with all students throughout their coursework so that they can successfully be retained in the program and complete the program in the timely fashion.

Statement of Potential Enrollment and Graduates

Products resulting from the graduate online certificate program include a new graduate level course – MPH 6009 Capstone Experience in Ethnic Health & Health Disparities, and a new set of public health professionals with specialized training and expertise in ethnic and rural health disparities. MPH 6005, 6007, 6008 are existing online courses taught by Dr. Bailey that are being bundled with MPH 6009 (pending approval) for the certificate program. Students in the certificate program will be enrolled simultaneously with students in the MPH program. The number of times that each existing MPH course is offered will not be increased. The average number of students in each aforementioned course is currently 20 students. By the end of year 3, we anticipate that the average number of students enrolled in each course will be 30 and the average number of students who will annually graduate with a certificate in Ethnic and Rural Health Disparities will be 10.

Our three-year projections for the average number of students in each course (30) and the average number of students that will annually graduate (10) are based upon the average number of students in the courses presently and the impact of the growing interest and need among health professionals throughout eastern North Carolina and the United States for additional academic training in ethnic and rural health disparities issues. Because of the overall need from public health professionals and graduate students to obtain additional expertise in ethnic and rural health disparities particularly in eastern North Carolina and the fact that the Director and Co-Director will be marketing and promoting the program at conferences and events throughout North Carolina and the region, we anticipate the number of full-time students (taking 3 s.c.h. per semester) in ERHD program to be 20 along with 10 part-time students (taking 3 s.c.h. per academic year). Therefore, we anticipate 30 graduate students (sum of eligible full-time and part-time) in the ERHD Certificate Program by year three.

Results from this new graduate online certificate courses will include new strategies to use the online technologies for instructor’s podcast/webcast lectures, opportunities to hire an additional instructor as the program grows, and innovative ERHD student fieldwork projects. Outcomes of these activities are better prepared public health professionals in the areas of ethnic and rural health disparities. We expect that our certificate graduates will have a direct impact in developing more culturally competent public health programs in eastern North Carolina and the state thereby playing a critical role in reducing ethnic and rural health disparities. Because this certificate program is entirely online, more ethnically diverse public health professionals and graduate students will be able to participate, obtain specialized public health skill sets, and become apart of the new generation of public health professionals.

Future Plan to Evaluate Cultural Competency

The major purpose of this Graduate Certificate Online program is to provide an online, 12 semester hour certificate program for working health professionals and graduate students in ethnic and rural health disparities. We also want to improve students’ level of cultural competency in the areas of ethnic and rural health disparities.

Cultural Competency

Cultural competence has come to represent the ability of health care providers to interact with patients who are different from themselves. This difference implies ethnicity, but from a broader perspective encompasses differences that include gender, race, age, religion, culture, language, education, socioeconomic status, and permutations of these parameters.

Cultural competence has also been described as a set of behaviors, knowledge, attitudes, and policies that come together in a system, organization, or among health professionals that enables effective work in cross-cultural situations. They should also have the capacity to: (1) value diversity, (2) conduct self-assessment, (3) manage the dynamics of difference, (4) acquire and institutionalize cultural knowledge, and (5) adapt to diversity and the cultural concepts of the communities they serve.

Public health professionals must be able to shift from a problem or diseased-focused perspective to the human and contextual perspective of the public. They must also be able to recognize and acknowledge their own biases, prejudices, and stereotypes. This change of perspective includes considering how the public’s beliefs, values and concerns might influence communication and public health intervention programs. To succeed in this more public-centered approach, public health professionals must enhance their communication skills necessary to negotiate effectively and collaborate with the ethnically diverse public to optimize outcomes that work within the public’s world.

To assess and improve one’s level of cultural competency, three areas must be addressed: (1) knowledge, (2) attitude, and (3) skills. Cultural competence efforts seek to increase public health professionals’ knowledge of cultural beliefs, practices, and changing attitudes toward health care and health seeking behavior. Recognizing disparities in the incidence and occurrence of disease, especially among racial and ethnic populations, is also an important aspect of the cultural competency knowledge base.

The second key component of cultural competence is attitude. Addressing attitudinal issues (e.g. enhancing self-awareness of one’s attitudes toward people of different racial, religious, or socioeconomic backgrounds) can minimize the influence of stereotypes and beliefs on the recognition, diagnosis, and treatment of disease, enabling public health professionals to provide better programming. Attitudinal components of cultural competence are often the most challenging areas in which to educate public health professionals.

The final key component of cultural competence is skills. To incorporate cultural knowledge and culturally sensitive attitudes into public health programming, public health professionals must be able to integrate, synthesize, and apply them in the form of skills. These skills include: (1) integrating knowledge and attitudes by demonstrating respect and validating other cultures; (2) Applying knowledge and attitudes to discover the cultural context of the public health problem as well as the public’s needs, expectations, and culturally appropriate resources; (3) Adapting communication skills to situations in which English is not the common language between public health professional and the public; (4) Demonstrating proficiency in the use of interpreters; and (5) Considering the influence of culture on all aspects of public health programming including negotiation, problem solving, diagnosis, management, and intervention to achieve optimal public health outcomes.

In general, enhancing cultural competence among public health professionals shows that public health is more responsive to the needs of diverse populations, improves the quality of public health programs and improves the relationship between the public and the public health professionals.

Strategy to Evaluate Cultural Competency

The basic strategy to evaluate cultural competency of students who participate in this graduate certificate online program is as follows:

Ask student to complete a semi-structured questionnaire at the beginning of their first ERHD course and complete a semi-structured questionnaire at the end of the final ERHD course. Other than the testing associated with each ERHD course, this will be the only assessment tool used to evaluate students overall level of cultural competency as it relates specifically to ethnic and rural health disparities. Students will be informed of their cultural competency assessment at the conclusion of their final course.

The instruments developed to assess cultural competency will consist of pre-test/post-test and attitudinal semi-structured questionnaires. The pre-test/post-test and attitudinal semi-structured questionnaire has been used to assess cultural competency for service providers. The courses and research conducted under this Certificate Program are exempt because all research uses education test, survey procedures, interview procedures or observation of student behavior.

Cultural Competency Evaluation

Activity	Question	Instrument & Alternative Timeline	Statistical Analysis
Develop and implement online graduate certificate courses
Assess student attitudes toward understanding the dynamic forces contributing to cultural diversity	1) How well are you able to describe the communities of color in eastern North Carolina? 2) How well are you able to describe within-group differences? 3) How well are you able to describe the strengths of the groups of color in eastern NC? 4) How well are you able to describe the social problems of the groups of color in eastern NC? 5) Do you know the prevailing beliefs, customs, norms, and values of the groups of color in eastern NC?	Pre-test (Fall 2010 or Spring 2010)/ Post-Test (Spring 2011)	Descriptive analysis, Paired-T comparison, and Analysis of Variance
Assess student understanding of the role of cultural, social, and behavioral factors in determining the delivery of public health services	1) Are you familiar with limitations of mainstream diagnostic tools as applied to people of color? 2) Would you be willingly to share information with people of color about your personal or professional background? 3) Would you share some of your personal feelings with people of color? 4) Would you assess persons of color acculturation or assimilation with respect to the mainstream culture? 5) How well do you see cultural strengths and resources when planning public health programs to people of color?	Pre-test (Fall 2010 or Spring 2010)/ Post-Test (Spring 2011)	Descriptive analysis, Paired-T comparison and Analysis of Variance
Assess student socicultural understanding of the ethnic and rural diverse demographics	1) Please list the cultural group(s) of color who resides in eastern NC, how much of the overall population this represents and what adjectives would you use to describe these groups? 2) To what extent do you know the following sociodemographic characteristics within communities of color and rural populations in eastern NC: Unemployment rates, income differentials, educational attainment, birth/death rates, crime rates, homicide rates, owner occupancy rates? 3) To what extent do you know the following resources regarding people of color and those who live in rural areas: Informal supports and natural helpers, formal social service agencies, formal leaders, informal leaders, business people, advocates, and clergy or spiritualists?	Pre-test (Fall 2010 or Spring 2010)/ Post-Test (Spring 2011)	Descriptive analysis, Paired-T comparison and Analysis of Variance Theme & Pattern Analysis CDC EZ Text
Assess greater understanding of specific ethnic and rural health disparity issues such as cancer, heart disease, substance abuse, smoking and HIV/AIDS	MPH 6005, MPH 6007, MPH 6008 and MPH 6009	Course exams, discussion board answers, chatroom answers, fieldwork projects/proposals	Thematic and Pattern Analysis CDC EZ Text

In conclusion, we not only want to graduate students who successfully complete 12 credit online course hours in ethnic and rural health disparities courses, but we also want to improve their level of cultural competency in these areas of expertise. We feel that enhancing cultural competence among public health professionals shows that public health is more responsive to the needs of diverse populations, improves the quality of public health programs and improves the relationship between the public and the public health professionals.

Organizational Information

East Carolina University, with over 25,000 students, is the third largest constituent institution of the University of North Carolina. It is a public doctoral university committed to meeting the educational needs of North Carolina. It offers baccalaureate, masters, specialist, and doctoral degrees in the liberal arts, sciences and professional fields, including medicine and nursing. The campus is located in Greenville, North Carolina, a city of more than 72,000 and the hub of business, health care, and education in the eastern region of the state. It is within a 75 minute drive of Raleigh, the state capitol, and close to the Atlantic Coast beaches.

Dr. Eric Bailey, Ph.D., M.P.H. will manage and supervise the implementation of the overall project as well as develop promotional materials and teach three of the certificate program courses – MPH 6005, MPH 6007, MPH 6008 and team teach MPH 6009.

Principal Investigator and Program Director, Eric Bailey, Ph.D., M.P.H., Professor of Public Health and Anthropology, is trained and well suited to carry out this work. Dr. Bailey has 20+ years of post-graduate work experience in the fields of medical anthropology and public health. He has taught college courses for over 20 years and during the past four years at East Carolina University he has transitioned all of his college courses to distance education using the online technology provided by East Carolina University. In addition to his years of teaching college courses, Dr. Bailey has practical public health administrative experience because he worked as a Health Scientist Administrator and Program Director for the National Institutes of Health.

Dr. Bailey also has broad-based research experience in several chronic diseases including hypertension, diabetes, prenatal care, cancer, alternative medicine, HIV/AIDS and has published research findings in scholarly journals and lectured for the past 25 years on issues related to medical anthropology, multicultural and multiethnic health care utilization, alternative medicine, and community health and cross cultural health programs. Along with publishing scholarly journal articles, Dr. Bailey is the author of five academic books focused on ethnic health and health disparities.

Dr. Justin Moore, Ph.D., M.S. will serve as Co-Program Director of the program and direct the MPH 6009 course - Capstone Experience in Ethnic Health and Health Disparities. Dr. Moore is an Assistant Professor in the Department of Public Health and has over 10 years of research in public health. Since joining the Department of Public Health at East Carolina University, Dr. Moore has received federal and private support for his research grants and became the Director for Research in the department.

Cost Effectiveness

This project aims to graduate new public health professionals who will have acquired a new set of public health skills designed to be more culturally competent in the field of public health and to be more culturally competent in ethnic and rural health disparities. Using the online, distance education technology will keep higher education access cost down for students and allow East Carolina University to deliver high quality college education throughout the state of North Carolina in an effective and efficient manner.

Classification of Instruction Program and Code

The classification of Instructional Program (CIP) title and six-digit code for the Ethnic and Rural Health Disparities (ERHD) Graduate Certificate Online Program is listed in the category of Public Health Education and Promotion – 51.2207.