Western Regional Examining Board (WREB) Dental Hygiene Examination

Correct: In the PRECEDE-PROCEED model, Phase 3 is the Educational and Ecological Assessment. This phase requires the health education specialist to identify the predisposing factors (knowledge, attitudes, beliefs), reinforcing factors (social support, peer influence, rewards), and enabling factors (skills, resources, barriers) that lead to the desired health behavior. By focusing on these factors, the MCHES can move the program away from a reliance on potentially coercive high-value gifts and toward a more sustainable, theory-based behavioral intervention.

Incorrect: The second option focuses on compliance and transparency regarding third-party gifts, which is a regulatory or legal concern rather than a health education strategy for chronic disease management. The third option focuses on Phase 4 (Administrative and Policy Assessment) without addressing the underlying behavioral drivers identified in Phase 3. The fourth option describes Phase 1 (Social Assessment) but incorrectly targets only executive leadership and financial goals rather than the health and quality of life of the priority population (the employees).

Takeaway: Phase 3 of the PRECEDE-PROCEED model is critical for identifying the predisposing, reinforcing, and enabling factors that drive health behaviors in chronic disease management.

Correct: The Socio-Ecological Model (SEM) is the most appropriate framework because it emphasizes that health behaviors are shaped by multiple levels of influence, including individual, interpersonal, organizational, community, and public policy. In a corporate setting, addressing burnout and turnover effectively requires moving beyond individual-level interventions (like stress workshops) to address interpersonal factors (supervisory support) and organizational factors (workload policies) identified in the audit.

Incorrect: The Health Belief Model, Transtheoretical Model, and Theory of Planned Behavior are primarily individual-level theories. While they are effective for understanding personal perceptions, readiness to change, or behavioral intentions, they do not provide the necessary framework to systematically address the organizational and environmental determinants of health that were flagged as the root causes of the turnover in the audit report.

Takeaway: Effective health education in organizational settings requires an ecological approach that targets multiple levels of influence, including systemic and environmental factors, rather than focusing solely on individual behavior change.

Correct: Using standardized tools like the Suitability Assessment of Materials (SAM) allows for a systematic evaluation of content, literacy level, graphics, and cultural appropriateness. Combining this with the Teach-Back method training for staff ensures that communication is not just readable but actually understood by the recipient, which is a core competency in health literacy improvement and aligns with health education principles.

Incorrect: Increasing font size and adding a glossary are helpful but insufficient if the underlying language remains overly complex or legalistic; it does not address the suitability of the content. High-level webinars led by doctors may be too technical and fail to address the specific literacy gaps related to policy navigation and insurance terminology. Mandatory testing for clients creates a barrier to access rather than improving the organization’s communication and violates principles of equitable health education and accessibility.

Takeaway: Effective health literacy improvement requires both the systematic assessment of written materials for suitability and the implementation of interactive verification techniques to ensure comprehension.

Correct: Incidence rate is the most appropriate measure for evaluating the effectiveness of a prevention program because it specifically counts new cases arising in a population at risk over a defined period. In the context of a risk assessment for a humanitarian carve-out, demonstrating a reduction in the rate of new infections (incidence) provides direct evidence of the initiative’s preventive impact.

Incorrect: Period prevalence is an unsuitable metric for evaluating a new intervention because it includes both pre-existing and new cases, which can mask the actual impact of the initiative on preventing new occurrences. Cross-sectional studies are limited because they provide a snapshot of a population at a single point in time and cannot establish a temporal sequence or causality. Crude death rates are too broad as they are influenced by the overall age distribution and other unrelated causes of mortality, failing to isolate the specific morbidity changes related to the water-purification initiative.

Takeaway: Incidence is the essential epidemiological metric for assessing the impact of health interventions on the occurrence of new cases within a specific timeframe.

Correct: Collaborative negotiation (an integrative approach) is the most effective strategy for resolving conflicts in health education partnerships. It focuses on identifying the underlying interests of all stakeholders—in this case, the need for high participation and the requirement for ethical integrity—to find a ‘win-win’ solution. This approach builds trust, maintains the partnership, and ensures that the program remains aligned with professional standards and organizational values.

Incorrect: Proposing a compromise is often a ‘lose-lose’ scenario where neither party’s needs are fully met, and the ethical concern remains partially unaddressed. Yielding to the partner (accommodation) prioritizes the relationship over professional ethics, which can lead to long-term reputational risk and program failure. Asserting authority (competing) may resolve the immediate ethical issue but is likely to damage the partnership, leading to a lack of cooperation or withdrawal of support in future initiatives.

Takeaway: Collaborative conflict resolution in health education ensures that program integrity is maintained while fostering sustainable and mutually beneficial stakeholder partnerships.

Correct: Outcome evaluation is the correct choice because it is specifically designed to measure the long-term effects of a health program, focusing on health status indicators such as morbidity (disease prevalence) and mortality. In the PRECEDE-PROCEED framework, this corresponds to the final evaluation phases that assess the ultimate health and quality-of-life goals of the intervention.

Correct: Fidelity refers to the extent to which a program or intervention is delivered as it was originally intended or designed. In this scenario, the specialist is checking if the workshops followed the standardized curriculum and timeframes, which is a direct assessment of adherence to the program protocol.

Incorrect: Reach is incorrect because it measures the proportion of the priority population that participates in the program, rather than the quality of the delivery. Dose received is incorrect because it focuses on the participants’ engagement, satisfaction, and use of materials rather than the educator’s adherence to the manual. Context is incorrect because it refers to external environmental factors or organizational conditions that might influence implementation, rather than the internal consistency of the program delivery itself.

Takeaway: Fidelity is the critical process evaluation component used to ensure that an intervention is implemented according to its original design and protocol.

Correct: Facilitating a multi-sectoral coalition to advocate for policy changes is the most effective strategy because it addresses the root cause identified in the gap analysis: structural barriers and restrictive policies. In the context of health equity and the Socio-Ecological Model, moving beyond individual education to policy-level intervention is essential for sustainable change. This aligns with MCHES competencies regarding advocacy and policy development to improve health outcomes for marginalized populations.

Incorrect: Implementing individual-level workshops based on the Health Belief Model is incorrect because the scenario specifies that awareness is already high, but structural barriers are the limiting factor. Distributing standardized brochures is a passive communication strategy that fails to address the specific needs of marginalized groups or the underlying policy issues. Conducting a secondary needs assessment using only quantitative bank records is insufficient because it ignores the qualitative community context and the need for active advocacy to change the identified restrictive policies.

Takeaway: To achieve health equity, health education specialists must prioritize advocacy and policy-level interventions that address structural barriers rather than relying solely on individual behavior change models.

Correct: A systematic synthesis in health education requires appraising the quality of diverse evidence (qualitative, quantitative, and mixed-methods) and organizing those findings within a theoretical framework like the Socio-Ecological Model. This ensures that the intervention addresses the complex layers of health behavior, from individual knowledge to organizational policy, which is essential for mitigating the risk of program failure identified in the audit.

Incorrect: Focusing only on longitudinal studies is too narrow and may exclude valuable cross-sectional or qualitative data that inform organizational change and interpersonal dynamics. Vote-counting is a recognized but weak synthesis method that ignores study quality and the magnitude of effects, leading to potentially biased conclusions. Restricting the search to high-impact journals or a very narrow timeframe may exclude relevant, high-quality evidence specific to the workplace setting or foundational theories that remain valid beyond a three-year window.

Takeaway: Effective literature synthesis for health programs requires a systematic appraisal of evidence quality and the integration of findings across multiple ecological levels to ensure theoretical and practical alignment.

Correct: Integrating a Community Advisory Board (CAB) during the social assessment phase (Phase 1 of PRECEDE-PROCEED) is a critical control for ensuring that health programs are grounded in the community’s self-identified needs and social context. This participatory approach aligns with MCHES competencies regarding stakeholder engagement and community assessment, reducing the risk of intervention irrelevance by ensuring that the community’s own perceptions of their needs are the starting point for program design.

Incorrect: Adopting top-down logic models from different geographic areas fails to account for local cultural nuances and specific community barriers. Relying solely on state-level secondary data provides a broad overview but lacks the granular, community-specific insight needed for local clinic programming. Focusing exclusively on clinical biomarkers in summative evaluation measures medical outcomes but does not address the risk of initial program misalignment with social determinants or patient priorities, as it only evaluates the end result rather than the appropriateness of the design.

Takeaway: Engaging community stakeholders during the initial assessment phases of planning models is the most effective way to ensure health programs are culturally relevant and socially grounded.