By Lei-Shih Chen

from GeneWatch 28-1 | Jan-May 2015

Envision a pregnant woman living in a small town. Regardless of her age during the pregnancy, doctors recommend several prenatal genetic tests. These tests include the quadruple screen test, invasive prenatal genetic testing, and the latest non-invasive prenatal genetic testing (as a "replacement" for amniocentesis). Similar to many other prospective parents in the United States, this woman and her partner face uncertainty, anxiety, and challenges of informed decisions, understanding of the testing process, and the interpretation of test findings. While the obstetrician explains those prenatal genetic tests to this couple in the limited visiting time, the conversation is filled with medical jargon and terminology. Additionally, this small town lacks genetic counselors. If this couple wants to see a genetic counselor to learn more about prenatal genetic testing, they will have to travel to a big city. After the delivery, when this couple is exhausted, they are asked to decide whether or not their baby will undergo the newborn screening test. Then they have to make another decision regarding the use of the residual blood from this newborn screening test.

This experience is quite common for many Americans. The endless amount of genomic information presented to patients and the general public is often overwhelming. Along with prenatal genetic testing, individuals may also learn about BRCA1/2 cancer genetic testing from the mass media because of the "Angelina Jolie effect." In addition, people may hear about stem cell research, gene therapy, personalized medicine, direct-to-consumer genetic testing, and genetically modified food from various sources. The reality is that genetics and genomics impact Americans' lives. Thanks to hard-working scientists, genomic technologies have advanced dramatically and genomics information has exploded rapidly. Whether you like it or not, there is no way to avoid it. The issue is that public and patient education in genomics still lags behind genomic innovations, which leads to the incomplete understanding of genomic discoveries and difficulties in making informed decisions among the lay public. Unfortunately, there are inadequate numbers of genetic professionals to educate patients and the general population.  One of the solutions for solving the shortage of genetic professionals is to involve health educators.

So, who are health educators? Health educators are members of the public health workforce, experts in public health education, health behavioral changes, health program planning, implementation, and evaluation. There are over 75,000 health educators in the United States working in diverse settings, such as hospitals, K-12 schools, communities, universities, governments, worksites, and non-profit organizations. Unlike traditional health care providers, health educators are trained to "educate" people. Education is not merely giving a talk or handing someone a brochure or flyer. It involves a systemic, complex learning process of addressing people's knowledge, beliefs, values, and culture. To qualify as a health educator, one must obtain a degree in health education, health promotion, health behavior, community health, or a related field. The National Commission for Health Education Credentialing, Inc. offers Certified Health Education Specialist (CHES) certification for entry-level health educators and Master Certified Health Education Specialist (MCHES) for the advanced-level health educators. Certain states require that health educators must have CHES or MCHES certification to entitle their work. As health educators are experts in educating the lay individuals and general public, they are the ideal candidates for bridging the gap between the health care system and the lay community through translating complex genomic information to lay individuals, enhancing general public's genomic literacy, designing educational materials, enhancing communication between doctors and patients, and developing genomics education programs and evaluating the effectiveness of such programs. 

Researchers in the health education field have called for genomics training for health educators since 1993. During the past decade, several groups have provided genomics training for health educators or public health workers in general. Here in the Department of Health Education at Texas A&M University, I initiated a health promotion and genomics lab in 2009 and  later started offering a course on health promotion and genomics to educate graduate students. This course covers the basic genomics content, latest development in genomics, and state-of-art literature in public health genomics. Students are required to write a manuscript related to genomics. This year, another course - advanced health promotion and genomics - was developed for graduate students who previously took the health promotion and genomics course. Students are anticipated to gain more in-depth knowledge of genomics. As to undergraduate students, one of the doctoral students is working with me to design an online training in cancer genomics and plans to implement it this year. 

During 2010-2013, my research team developed and offered a theory-based continuing education program in genomics for health educators in the state of Texas. Along with the purpose of increasing participants' genomics knowledge, the curriculum of the genomics education program addresses intention, attitudes, and self-efficacy. These components have proven to be strong predictors for affecting health educators' practices in genomics. About 600 Texas health educators participated in this genomics education program. After the training, participants significantly adopted genomics skills into their work. Based on the success of the initial program, we have been creating new advanced curricula in genomics for health educators who have attended our initial training.[1] We also plan to offer both initial and advanced curricula for more health educators in Texas. The next goal is to expand the Texas-based genomics education program to health educators nationwide.

Despite ongoing genomics education activities at universities for health education students and beyond universities for practicing health educators, challenges remain. Genomics is still not a mainstream topic in the health education field. There are insufficient health education faculty and students trained in genomics. At the university level, genomics is not a required course for most health education programs. Although a genomic forum was established at the American Public Health Association, other traditional health education organizations are still missing the genomics theme. Accordingly, additional genomics education for health educators and increased funding to support genomics education in the health education field are strongly needed in the near future.

Lei-Shih Chen, PhD, CHES, is Associate Professor of Health and Kinesiology at Texas A&M University.



1. Both of these projects were funded by the Cancer Prevention and Research Institute of Texas (PP100214 and PP140210).

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