Instructional Design

Background

As with any health department, the Malheur County Health Department (MCHD) in Oregon is committed to and responsible for promoting and protecting the health of its community through collaboration, education, prevention, and compassionate care delivery.

MCHD is our client for this project, and per state-wide efforts to improve health equity, MCHD needs high-quality, thoughtfully designed health equity training. Because many people in the health department were educated, hired, and trained before the prioritization of health equity, both experienced and new employees need to learn what health equity is. At a program level, coordinators must also know how to prioritize health equity to drive improved health outcomes.

Socio–physical Context for the Problem/Opportunity

As part of the county government, MCHD operates under a board of locally elected officials overseeing local decision-making and activity. As part of the state of Oregon, MCHD operates under the Oregon Health Authority, which provides the majority of program funding and rules. MCHD operates between the needs and goals of both county and state-level priorities.

The Oregon State Health Improvement Plan (SHIP) ultimately determines the direction of all the work happening at more local levels and drives funding and program decisions. The SHIP, also known as Healthier Together Oregon, has made health equity the top priority for the healthcare system, including public health.

Problem

As part of a new state-wide initiative, Oregon required health equity implementation within public health departments. For public health departments to receive and maintain funding from the state, they are required to have a Health Equity Plan in place with staff training and evidence of implementation at the program level. 

Solution

For our team and this project, we are focused on the need for a practical tool to apply health equity training at a program level within a public health department. This practical tool will be a job aid called an Equity Lens. The lesson plans we develop will help people address the need to improve programs within local public health departments, and over time, the impact will affect the health of the whole community. The opportunity to provide training and tools at a program level will tie directly to the SHIP vision for all:

"Malheur County will be a place where health and well-being are achieved across the lifespan for people of all races, ethnicities, disabilities, genders, sexual orientations, socioeconomic status, nationalities, and geographic locations." 

Analyses and Key Findings of Training Needs, Learners/Environment, and Tasks

Findings

Training Need

When analyzing the training needs, we found that the goal of MCHD was to provide awareness of health equity, which the client requested to be done through training and the application of job aids. At a higher level, the goal was to connect program-level work within the health department to the state goal to eliminate health inequities. This goal was a shift for many employees, who viewed their goals as service delivery, in a broad sense, without being expected to consider who might not be being served. This goal would require an attitude shift.

Given that our need was rooted in a lack of information and resources, we found that it would be best to address the need with training on health equity to establish critical terms and concepts via evidence-based practices supplemented with a job aid known as the Equity Lens. The Equity Lens is a practical tool for applying health equity training at a program level within a public health department. The goal for learners was to have them report increased understanding and awareness of the opportunity to grow, as well as increased motivation and resources to implement the learning. 

Learners/Environment

Through interviews with the client, we found that our learners were a group of 10 program coordinators of diverse backgrounds and social makeup, with varying degrees of knowledge on health equity concepts. 

As equity topics tend to have an increasing polarization due to the political landscape, and with the knowledge that attitudes and preconceived knowledge from prior experiences may inform our learner's actions, it was important to us that we had a plan to get our learners all on the same page while sticking to plain language and avoiding jargon as much as possible. We also understood that while many learners may have prior experiences in life that allow for the ready adoption of equity concepts, some may have less exposure and be just as comfortable. As such, we deemed it necessary to frame concepts as continuous learning and improvement opportunities in efforts to foster a safe learning environment while also stressing the Equity Lens as a valuable tool so that it is seen as worth their time to learn how to use a new, complex tool. We also discovered that the health department did not have the resources to build an enduring, self-paced training, so we would need to structure the training as a live, instructor-led session. 

Tasks

After determining that training was needed, establishing our goal for the training, and identifying our learner audience, our next step was developing learning objectives that would organize and structure the intended outcomes for our learners. 

We first identified the primary learning type as knowledge and skills, then created streamlined learning goals for the learners, and finally established any prerequisite knowledge learners would need to meet the learning goals. If they required prerequisite knowledge, we knew we would need to provide it within the training.

While designing the lesson plan for our training, which I will discuss next, we changed our learning goals to reflect more accurate learning needs as we acquired a better grasp of the project's scope. After all, it is an iterative process. Find the full report for analyses in Appendix A.

Designing the Lesson Plan

For this project, we focused our lesson plan (Appendix B) on the need for a practical tool to apply health equity training at a program level within a public health department, a goal that, if implemented, would affect the whole community. 

When designing, we utilized backward design. As the name suggests, we started with the end in mind and worked backward. We began by identifying what we wanted the learners to know by the end of the training, then created an assessment to measure the learning, and then planned the sequence of lessons. We developed an alignment tracker (Appendix C), a matrix, to ensure that we only included aspects in the lesson that contributed to student learning and success. This matrix aligned our learning goals with planned activities, connected them with the learning principle that supported that approach and listed the rationale for the principles utilized. This kept us mindful of an evidence-based approach. For instance, if the activity was to share thoughts or discuss in a group and allow learners to socially learn and construct knowledge together, the learning science principle that was tied to was the Social Cognitive Theory.

Considering limitations with technology and preference, we determined that our particular audience would be best served by in-person instructor-led training. This consideration guided our decisions to incorporate group discussions into our activities and tailor our facilitator notes to in-person instruction.

Development of Instructional Materials

When developing the instructional materials, we used the lesson plan as a guide and began by building a presentation in Google Slides. Later, we moved the presentation to Canva for more design freedom. This change also provided more opportunities for interactive elements, which is vital for learner engagement.

We focused on establishing meaning in the learning through opportunities for audience connection with the material while also allowing for demonstration of our primary job aid. We also incorporated activities that allowed learners to both connect to previous knowledge and utilize their new knowledge.

Our subject matter expert (SME), who doubled as our client, helped determine what physical limitations would be present at the location of this training environment, as well as the attitudes and knowledge of the learners themselves and their limitations with technology. Answers to those questions supported the design of a presentation suited for in-person instructor-led training. This training delivery method was an essential distinction from virtual instructor-led training, as it affected the language used in the speaker notes and the facilitation language for activities and other learner involvement.

Due to learner and environment limitations, we created a learner guide (Appendix D2) that would serve as a workbook with handouts and activities included. This was to ensure that learners could have the resources at their fingertips, allowing them to take notes and quickly reference material they may have questions about during the presentation. Our learners would not have access to laptops, so a learner guide made the training more accessible for this audience. 

We also designed a facilitator guide (Appendix D3), which visually mirrors the learner guide but functionally includes guiding material before, during, and after the training. It also differs in that the slides for the presentation include speaker notes, complete with facilitating language.

After we understood where activities and job aids would fit in our presentation, we designed them and placed them in both the facilitator and learner guide. 

We focused on ensuring that activities and job aids reflected our learning goals. For example, the Social Identity Wheel activity connects to four out of seven learning goals, and the Equity Lens activity connects to all of them, tying them together in a single culminating activity that uses their new job aid.