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Volume
2:
No. 2, April 2005
TOOLS AND TECHNIQUES
Genomics and Public Health: Development of Web-based Training
Tools for Increasing Genomic Awareness
Jennifer Bodzin, MPH, Sharon L.R. Kardia, PhD, Aaron
Goldenberg, MA, MPH, Sarah F. Raup, MPH, Janice V. Bach, MS, Toby
Citrin, JD
Suggested citation for this article: Bodzin J, Kardia
SLR, Goldenberg A, Raup SF, Bach JV, Citrin T. Genomics and
public health: development of Web-based training tools for
increasing genomic awareness. Prev Chronic Dis [serial online] 2005 Apr [date cited]. Available from: URL:
http://www.cdc.gov/pcd/issues/2005/
apr/04_0133.htm.
Abstract
In 2001, the Centers for Disease Control and Prevention funded
three Centers for Genomics and Public Health to develop training
tools for increasing genomic awareness. Over the past three
years, the centers, working together with the Centers for Disease
Control and Prevention’s Office of Genomics and Disease
Prevention, have developed tools to increase awareness of the
impact genomics will have on public health practice, to provide a
foundation for understanding basic genomic advances, and to
translate the relevance of that information to public health
practitioners’ own work. These training tools serve to
communicate genomic advances and their potential for integration
into public heath practice. This paper highlights two of these
training tools: 1) Genomics for Public Health Practitioners:
The Practical Application of Genomics in Public Health
Practice, a Web-based introduction to genomics, and 2) Six
Weeks to Genomic Awareness, an in-depth training module on
public health genomics. This paper focuses on the processes and
collaborative efforts by which these live presentations were
developed and delivered as Web-based training sessions.
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Introduction
As genomics research continues to expand and identify potential applications
for disease prevention, departments of health as well as public health
practitioners will need to become increasingly aware of genomics as a public
health tool. In 2001, the Centers for Disease Control and Prevention (CDC)
produced a set of competencies to help integrate genomics into public health
practice and training (1,2). Genomic competencies were developed for all members
of the public health workforce, along with specific competencies for each
functional area of public health: administration, clinical, epidemiology, health
education, laboratory, and environmental health (3). These competencies are
described in detail and are available from
www.cdc.gov/genomics/training/competencies/comps.htm
(4). Based on these competencies, a public health worker in any
program at any level should be able to demonstrate a basic
knowledge of the role genomics plays in disease development. This
knowledge is essential for public health practitioners to
integrate genomics tools into public health practice and to
educate the public.
Currently, the public’s understanding
of genomics is derived primarily from the media, and the
scientific information is often incomplete and/or inaccurate
(5,6). As acknowledged in the 2002 Institute of Medicine report,
Who Will Keep the Public Healthy?, “because few in the
current public health workforce have the level of understanding
of genomics that is required today, major continuing educational
efforts must be undertaken to ready practicing public health
professionals to use genomics effectively” (7).
During the past few years, several genomics training tools have
been developed to help public health practitioners increase their
awareness of the impact of genomics on public health practice, such
as genetic testing for adult cancer, identifying genetically
at-risk subgroups susceptible to environmental exposures, or
developing new genomic technologies. These training tools aim to
provide a foundation for understanding basic genomics (e.g., DNA
mutations, inheritance patterns). They also help practitioners identify and translate the relevance of genomics to their own
work (e.g., using family history as a genomic–environmental
indicator of a person’s own risk of chronic diseases).
Traditionally, genomics training tools have included books,
CD-ROMs, lectures, workshops, and presentations at conferences or
meetings. The Genomics Toolkit is a good example of a recently
developed guide designed to deliver an inventory of effective
genomic tools for public health practitioners to use in program
technical assistance (2,8). With improved technologies now
available for developing high-tech presentations — such as
synching audio, video, and PowerPoint — using the
Internet to provide genomics training sessions is a logical, convenient
way to increase the genomic literacy of public health
professionals.
Two Web-based genomics training tools have been developed to
provide genomics education to large numbers of public health
practitioners nationwide. Genomics for Public Health
Practitioners: The Practical Application of Genomics in Public
Health Practice serves as an introduction, while Six Weeks
to Genomic Awareness is a more in-depth series of six
training modules. Both training tools described in this article
resulted from the collaborative efforts of individuals from the
CDC’s Office of Genomics and Disease Prevention (OGDP), the
Michigan Center for Genomics and Public Health (MCGPH), the North
Carolina Center for Genomics and Public Health (NCCGPH), and the
University of Washington Center for Genomics and Public Health
(UWCGPH).
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Genomics for Public Health Practitioners: The Practical Application
of Genomics in Public Health Practice
Genomics for Public Health Practitioners: The Practical
Application of Genomics in Public Health Practice is a
Web-based introductory presentation aimed at increasing awareness
of the impact of genomics on public health and familiarizing
practitioners with some basic concepts of public health genomics.
Topic areas covered in this training tool include definitions
(e.g., genetics, genomics, the human genome project) and
applications of public health genomics (e.g., surveillance,
policy, education); potential interventions based upon genomic
information (e.g., modification of screening recommendations,
exposures to environmental factors); challenges facing public
health genomics (e.g., rapid commercialization of genetic tests,
equal access to interventions); and a description of how one
public health program incorporated genomics (e.g., Utah Health
Family Tree Study, CDC Family History Public Health Initiative).
Individuals who designed this tool developed content that would
be appropriate for public health professionals with no genomics
background or exposure. Conference calls, e-mails, and a Web
board for posting files were used to communicate ideas among the
many individuals and locations. After content was agreed upon, the
module was animated and narrated for use as a Web-based
presentation. An informal piloting and evaluation stage, during
which public health practitioners offered feedback, provided
insight on changes for the final product. Following approval by
the CDC, the final presentation was launched on the Web sites of OGDP and each Center for Genomics and Public Health on August 19,
2004.
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Six Weeks to Genomic Awareness
Creating the Six Weeks to Genomic Awareness series was
consistent with one of the main goals of the Centers for Genomics
and Public Health — to develop and provide genomics
training for the current and future public health workforce. An
existing collaborative relationship between the Michigan
Department of Community Health (MDCH) and the MCGPH afforded the
capacity for developing this kind of training. The Genomics Work
Group, a committee established to integrate genetics into chronic
disease programs at MDCH, and whose members include
representatives from the Bureau of Health Promotion and Disease
Control (e.g., cancer, cardiovascular, and diabetes programs),
the Bureau of Laboratories, and the Bureau of Epidemiology
(including genomics and newborn screening), requested help from
the MCGPH in developing a genomics training for MDCH staff. These
public health professionals agreed that all program staff within
their departments would benefit from introductory information on
the impact of genomics on a variety of public health issues.
Working with the MCGPH, the state genomics coordinator helped to
identify the topic areas most relevant for state health agency
employees.
During winter 2002, the plan for Six Weeks to Genomic
Awareness began to take form. First, partners at both the
MCGPH and the MDCH identified topics that would allow public
health practitioners to begin integrating genomics into the
functional areas of public health (administration, clinical,
epidemiology, health education, laboratory, and environmental
health). Twelve initial topics were identified along with
detailed learning objectives, terms, and concepts, additional
resources (such as Web sites), and interactive exercises. After
discussions with MDCH partners about desired format and length,
Six Weeks to Genomic Awareness was created as a six-module
course to be presented onsite at MDCH in 90-minute sessions
during the lunch hour through May and June 2003. Three members of
the MCGPH team, two professors at the University of Michigan
School of Public Health, two genetic counselors from the
University of Michigan, and the state genomics coordinator at MDCH developed and presented the seminar series.
The series was designed to provide an understanding about the
role of genomics throughout all public health fields, not just
those programs traditionally associated with genetics (e.g.,
newborn screening, maternal and child health). Additionally, the
course aimed to dispel myths about genetic determinism and
motivate health professionals to consider the ethical, legal, and
social implications of applying genomics within the public health
context. The Genomic Competencies for the Public Health
Workforce outlined by the CDC (4) were used as a backbone for
session development. Modules were designed to reflect the major
themes most relevant for public health — molecular
genetics, genes in populations and gene–disease associations, genetic testing, gene–environment interactions, ethical, legal, and social implications,
and state and national resources (Table
1).
Six Weeks to Genomic Awareness proved to be a
successful approach to educating Michigan’s public health
workforce at the state level. In all, 70 program staff
attended at least one session and 32 attended three or more.
Attendees represented a variety of bureaus (e.g., Bureau of
Laboratories), divisions (e.g., Epidemiology Services Division),
and programs (e.g., Cancer, Vital Records). Following each
session, evaluations were collected to gather feedback on the
content, format, and effectiveness of the presentations based on
a five-point rating scale (1 = poor, 5 = excellent). On average,
participants rated the sessions as “very good” in
terms of overall impression, usefulness of content, effectiveness
of presentation, and quality of visual aids and materials.
Participants also commented on the most useful part of each
session and what might have been confusing or least useful and
suggested additional topics to be covered in future genomics
training sessions. This information was used to improve and enhance each
presentation as part of the process for converting the series
into the Web-based training course described below.
Given the success of Six Weeks to Genomic Awareness in
providing genomics training to Michigan’s public health
workforce, MCGPH decided to convert the sessions into an online
format for dissemination to public health practitioners
nationwide. As work began on converting Six Weeks to Genomic
Awareness into an online course, the Association of State and
Territorial Chronic Disease Program Directors (CDD) approached
the MCGPH with a request for genomics training for its members.
Recognizing an ideal opportunity to improve and disseminate
Six Weeks to Genomic Awareness to a broader audience, the
CDD provided the funding necessary for ensuring the conversion of
the series into a Web-based format.
Presentations given during the MDCH sessions were used as the
basis for the online distance-learning modules; however, slides
needed to be updated to reflect changes in the science and to
include improved graphics and animations. In addition, the
90-minute format originally used was not appropriate for viewing
on the Web, and the content was repackaged into
20–30-minute modules more suitable for the Web. While the
evaluations collected from the MDCH onsite sessions had provided
important data on the needs of public health practitioners, wider
evaluation data were needed to develop the online sessions.
Individuals at the CDD, CDC, NCCGPH, and UWCGPH provided expert
and practical review and comment during the development of the
online course.
During June and July 2004, each session was filmed and edited,
and a Web template was created to synchronize the video and slide
presentations. Marketing tools, such as e-mail postcards, were
developed and distributed to CDD and CDC staff to announce the
launch of Six Weeks to Genomic Awareness on July 19, 2004.
A lobby page (available from www.genomicawareness.org*)
was developed to house all of the Six Weeks to Genomic
Awareness training modules and to provide an avenue for
individuals with questions, comments, or problems accessing the
module to contact the Michigan Center for Genomics and Public
Health.
The kick-off to the Web-based version of Six Weeks to
Genomic Awareness culminated on August 19, 2004, in a
one-hour live Webcast that brought together a panel consisting
of Six Weeks to Genomic Awareness presenters, Toby Citrin,
JD, and Sharon Kardia, PhD, in addition to Jean Chabut, BSN, MPH,
the Chief Administrative Officer at the Michigan Department of
Community Health. Public health professionals from around the
country called in or submitted questions in advance for the panel
to answer during the Webcast.
Between the time the modules became available online on July 19,
2004, and the end of October 2004, almost 3000 unique visitors
(as determined by an individual computer’s unique IP
address) had visited the Six Weeks to Genomic Awareness
Web site and had streamed more than 62,000 megabytes of content.
(To put this in perspective, a data transfer of 1000 megabytes is
equivalent to approximately 15 hours of viewing.)
Six Weeks to Genomic Awareness is also a cost-effective
approach to providing genomics education. Total costs for
developing the online course and producing the live Webcast were
roughly $35,000. This figure does not include payment for
instructor time, which was contributed. With almost 3000
individuals accessing Six Weeks to Genomic Awareness in
just the three months tracked so far, the per-person cost of
providing this genomics training is about $12. We fully expect
the number of viewers to increase over time and the per-person
cost of this training to decrease.
A voluntary evaluation also accompanied each of the Six
Weeks to Genomic Awareness presentations. An analysis of
evaluations (n = 41) from the first module,
“Introduction to Genomics: The Human Genome”
indicated that the majority of individuals viewing the session
found it to be “very good” or “excellent”
in terms of overall presentation (88%), usefulness of
content (76%), appropriateness of Web-based format (88%),
and relevance to their area of work (77%).
Participants who filled out evaluation forms represented 20
states nationwide and one international location. The majority of
the participants (63%) had more than 10 years of experience in
their field of work, and 30% worked in public health practice, 22%
in public health research, and 24% in health care provision.
Other individuals worked in a range of fields from basic science,
policy and legislation, nursing, geographic information systems,
education, and counseling.
Additional evaluation questions asked participants to measure
how knowledgeable they felt, how much new information they had
learned, how interested they were in learning more, and how
confident they felt in applying the information after viewing the
presentation, using a 10-point scale (1 = not at all, 10 = very).
Responses suggested that individuals completing the first module
felt relatively more knowledgeable about the human genome than
before (mean ± SD = 6.73 ± 2.07) and had learned new
information about the human genome (mean ± SD = 7.48 ±
2.12). Individuals also demonstrated a great interest in learning
more about the human genome (mean ± SD = 9.05 ± 1.30); however, they did not feel as confident that they would be able
to apply the information to their area of work (mean ± SD =
7.20 ± 2.42). At this time, the evaluation results from the
other modules continue to be compiled and analyzed.
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Collaborative Efforts
Both Genomics for Public Health Practitioners: The
Practical Application of Genomics in Public Health Practice
and Six Weeks to Genomic Awareness demonstrate the
importance of collaboration in developing genomics training
tools. Effective and appropriate education of professionals on
public health genomics requires the expertise and resources of
many individuals and organizations working together at all stages
of development, evaluation, implementation, and
dissemination.
Collaboration is vital because public health professionals
nationwide are at different levels of understanding and different
levels of integrating genomics into public health. Because public
health genomics is a new and emerging field, it is important to
encompass the needs of a wide range of audiences. Practitioners
should be involved in developing training methods and materials
to ensure that the final product will meet the needs of public
health professionals and will relate to their work, both in
terms of issues covered and language used to teach genomic
concepts. Academic institutions need to share genomic research
and knowledge and to provide insight into successful teaching
methods, as well as to help place science in a public health
context and to focus on important ethical, legal, and social
issues. Technical experts, who know how to produce a
distance-learning course in terms of software, equipment, and
technical support, are also needed to develop valuable Web-based
training. When the organizations giving and the organizations
receiving the training work together, the needs of all audiences
can be met more successfully.
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Future Projects
The successes of Genomics for Public Health Practitioners:
The Practical Application of Genomics in Public Health
Practice and Six Weeks to Genomic Awareness have
motivated new projects to expand genomics training in specific
disease areas. For example, at the UWCGPH, a presentation on the
genetics of obesity has been developed and disseminated via the
Web. Genetics of Obesity was offered as a live presentation at the
Chronic Disease Directors Diet, Nutrition, and Physical Activity teleconference
on October 14, 2004, and converted into an online audio-assisted presentation.
An accompanying brochure supplements the information found in the presentation
and directs public health practitioners to additional articles and Web
resources. In addition, the MCGPH, the MDCH, and the Michigan Cancer Genetics Alliance are collaborating to
develop a series of modules on cancer genomics for public health
professionals in the MDCH Cancer Section. This process began with
a needs assessment (developed with help from the NCCGPH) to target specific areas of interest. Genomics for Public
Health Practitioners: The Practical Application of Genomics in
Public Health Practice, Six Weeks to Genomic
Awareness, and the cancer and obesity training sessions describe a
three-tiered approach to providing genomics training:
introductory, in-depth, and disease-specific. By using this
approach, public health practitioners have the opportunity to
understand basic concepts before being exposed to more complex
topics.
Both the University of Michigan School of Nursing and School
of Dentistry have used Genomics for Public Health
Practitioners: The Practical Application of Genomics in Public
Health Practice and Six Weeks to Genomic Awareness.
Faculty from programs outside the University of Michigan have
also indicated interest in linking students to the Six Weeks
to Genomic Awareness as part of their genetic epidemiology
education. One clear advantage of Web-based learning is its wide
capacity for distribution; it extends easily to new and larger
audiences. There appears to be a great need for genomics
information by other health professionals and for training future
health professionals.
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Conclusion
An introductory module, Genomics for
Public Health Practitioners: The Practical Application of
Genomics in Public Health Practice, and a more
extensive training course, Six Weeks to Genomic Awareness,
have been developed to provide quality genomics training to
public health practitioners using two Web-based formats. Genomics for
Public Health Practitioners: The Practical Application of
Genomics in Public Health Practice uses computer-animated graphics with voiceover, whereas Six Weeks to Genomic Awareness employs live instructors in a lecture format that is taped
specifically for use on the Internet. Both tools can be used to
increase awareness of the impact genomics has on public health
practice, to provide a foundation for understanding genomic
advances, and to help translate the relevance of this information
to public health practitioners’ own work. These training
tools demonstrate the importance of a collaborative approach,
with organizations willing to share resources and expertise
throughout project development and implementation. The success of
both trainings also demonstrates the effectiveness of using the Web
as a tool for disseminating genomics education. By developing
Genomics for Public Health Practitioners: The Practical
Application of Genomics in Public Health Practice as a
Web-based introduction and converting Six Weeks to Genomic
Awareness into an online format, more than 3000 public health
professionals have been able to access genomics training via the
Web. Both trainings can be accessed through links from multiple
sources, including the Web sites for each of the Centers for
Genomics and Public Health and the CDC’s OGDP. Genomics for Public Health
Practitioners is available from www.cdc.gov/genomics/training/GPHP/default.htm.
Six Weeks to Genomic Awareness is available from www.genomicawareness.org*.
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Acknowledgments
The development of Genomics for Public Health
Practitioners: The Practical Application of Genomics in Public
Health Practice and Six Weeks to Genomic Awareness was
funded through several cooperative agreements with the Centers
for Disease Control and Prevention’s Office of Genomics and
Disease Prevention and the Association of Schools of Public
Health (S1946-21/23, S1957-21/23, S1958-21/23). The conversion of
Six Weeks to Genomic Awareness into an online
distance-learning course was also supported by funding from the
Association of State and Territorial Chronic Disease Program
Directors.
The authors acknowledge and thank the following: Jean C.
Chabut, BSN, MPH, and the public health practitioners at the
Michigan Department of Community Health for their input and
participation in the development of Six Weeks to Genomic
Awareness; Pam Clouser McCann, MS, CGC,
for her work in helping to develop the Six
Weeks to Genomic Awareness concept and the module on genomics resources and
for presenting the resources model for both the MDCH sessions and online
training; Catharine Wang, PhD, for reviewing this article; the staff of the
University of Michigan School of Public Health, Public Health
Genetics Program for contributing their time to developing and
reviewing slide presentations for Six Weeks to Genomic
Awareness; LaDene Larsen, RN, and the professionals of the
Association of State and Territorial Chronic Disease Program
Directors; Michael Glaza and the staff at Level Four Consulting;
and Melanie Myers, PhD, at the Office of Genomics and Disease
Prevention. Finally, the authors acknowledge and thank the
leadership and staff of all three Centers for Genomics and Public
Health for their collaborative efforts in developing both of
these genomics training tools.
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Author Information
Corresponding Author: Sharon L.R. Kardia, PhD, Michigan
Center for Genomics & Public Health, University of Michigan,
School of Public Health, Department of Epidemiology, 611 Church
St, Room 246, Ann Arbor, MI 48104-3028. Telephone: 734-936-0866.
E-mail: skardia@umich.edu.
Author Affiliations: Jennifer Bodzin, MPH, Aaron Goldenberg, MA, MPH, Toby Citrin, JD, Michigan
Center for Genomics & Public Health, University of Michigan,
School of Public Health, Ann Arbor, Mich; Sarah F. Raup, MPH,
Center for Genomics & Public Health, University of
Washington, Seattle, Wash; Janice V. Bach, MS, Michigan
Department of Community Health, Epidemiology Services Division,
Genomics Program, Lansing, Mich.
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