Date of Award


Degree Name

Doctor of Philosophy


Health Education

First Advisor

Ogletree, Roberta


Health care reform has been a controversial topic in America since the early 1900s (PBS, 2010). Today, the United States spends more on health care than any other industrialized nation (National Center for Health Statistics, 2011), but despite spending more, the U.S. has 46.3 million citizens who are uninsured (CDC 2009). To date, only two studies were located that analyzed health educators' behaviors related to health policy (Cooper, 1986; Holtrop, Price, & Boardley, 2000) and no studies were found using qualitative research designs to study health educators' experience with and recommendations for any policy issues, including health care reform issues. The purposes of this study were to explore recommendations from health educators for health care reform in relation to the different levels of the determinants of health ecological model and to examine potential new roles for the health education profession in achieving an effective health care system. An interpretive approach was used to gain contextualized, value-laden, specific knowledge from health educators to understand and interpret their perceptions about what needs to be in place on multiple levels for health care reform to be successful, and the Healthy People 2020 determinants of health ecological model (USDHHS, 2011) was used to elicit their perceptions. Twelve online, chat room focus groups and two online, chat room interviews were held with CHES and MCHES certified health educators over a three-week period. Three overarching themes emerged from the data: prevention, health literacy, and a focus on larger levels of the determinants of health ecological model. In addition to the overarching themes, recommendations were made at each level of the determinants of health ecological model, participants suggested an increased role of health educators in the medical and political setting, and responses revealed that participants in this study were involved in many advocacy experiences. Results of this study suggest that this group of health educators wants to see health care become a right for everyone. Participants want prevention and health education to become a social norm in society and a visible component of health care reform policies in the United States. Basically, there is a real need for our health care system to change into a system that does not focus on treatment after people get sick, but one that focuses on preventing illness and promoting wellness throughout the lifecycle and at multiple levels. Recommendations for the health education profession include compiling priority recommendations into a position statement or white paper to influence policy makers and politicians in Washington D.C. If health educators can become an interest group supporting health care reform proposals that include prevention and health education, then maybe they can influence health policies that promote their recommendations and ideals.




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