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In the 1990s, involvement in public policy setting became a significant health education skill as chronic and communicable disease management issues were joined by environmental hazard issues. Health education efforts and programs became geared to the home and to pre-school settings. In the past decade, new skills have been integrated into the health educator’s repertoire: social marketing; computer technology; distance learning; grant writing; evaluation; translating research into practice; and diffusing best practices. Issues such crisis management and terrorism, particularly bioterrorism and emergency preparedness have driven most government funding programs.

In 1998 the Competency Update Project began and in 2006 the second edition of the Competency-Based Framework for Health Educators was released by the National Commission for Health Education Credentialing, Inc.. The framework was reinvented to include 82 sub-competencies with three levels: Entry, Advanced I, and Advanced II. The certification examination was reinvented/revised accordingly in time for the October 2007 test (NCHEC, 2006).

Therefore, if “reinvention” is “in our blood”, is it not wise for us to learn more about and perhaps consider preparing for our own professional reinvention transfusions?

What Does It Mean to “Reinvent Yourself”?
“Reinvention is any type of change, from the material to the spiritual, in which you become a whole person or a different person, hopefully a better person, but certainly a changed person” (Davidson, 2001). Reinvention is about taking charge of who you are and where you’re going and what you’re doing, and it usually involves a willingness to take calculated risks, to start all over again, and to weather some setbacks.

Reinvention is a proactive, not a reactive activity. People who choose to reinvent themselves, for whatever reason, are, by and large, assertive people, with a sense of personal responsibility and accountability for their lives (Chandler, 2004). They reject the role of “victim of circumstance” and assume ownership, if not total control, of situations and set about seeing what they can do about them. They refuse to be part of the problem; they insist, instead, of being part of and often the driving force behind the solution (Chandler, 2004).

Personal reinvention can involve changes in one or more aspects of your life. Reinvention is about shifting, reframing, reformatting, restructuring your perspective, attitude, and actions to whatever degree is necessary in response to a particular trigger. It doesn’t have to imply or involve a wholesale upheaval in who you are and how you do things ― though for some of us at some time, it might actually come to that. It can mean adjusting your attitude toward life; your body and the shape it’s in or out of; your relationships or lack thereof with people, your community, your money, any higher power you might believe in; how and with whom you spend your discretionary time; and, the focus of this article, your work life.

If any profession should value and encourage reinvention, it’s health education. Over its 100-year history, health education has reinvented itself many times.

Originally, in the early 1900s, when epidemics were of major concern, health education was conducted through journalism, public speaking, and information sharing.

Beginning in 1910, interest shifted to alcohol and drugs and elementary school health programs were launched with an eye toward producing draft-worthy adults to better defend our country and its ideals. Health education was conducted through lectures and pamphlets.

This continued into the late teens and twenties, when, after the influenza epidemic and World War I, communicable diseases (particularly sexually transmitted diseases) were the focus of attention. Hospital and community-based lectures and pamphlets were enhanced by other methods of information communication: newsletters, films, filmstrips, and exhibits. Physical education was very important and went hand in glove with health education.

During the 1930s and 40s, and as the first masters degree program in public health education began to graduate students, community organizing became a major health education intervention.

In the 1950s, after World War II, veterans’ health was a major concern, and hospitals and clinics jumped onto the health education bandwagon. Written and oral communication skills continued to be the sine qua non of good health education, but there was a definite change in emphasis from publicist to educator.
Self-help and consumerism were all the rage in the 1960s as was social engineering. Health education began to include service planning and evaluation, behavior change, and group dynamics.

By the 1970s, worksite and occupational wellness programs were being implemented by employers, unions, health maintenance organizations, and public agencies. Interventions became behavior-change theory based and the focus shifted to lifestyles and personal behaviors and chronic disease management. Outreach and follow up became important health education tasks.

With the HIV/AIDS crisis in the 1980s, communicable diseases emerged once again as a major health concern and joined chronic disease management as a critical health education focus. Interventions included traditional information sharing strategies, community organizing and individual and group behavior change therapies. But new health education methods were also being introduced or solidifying their toe-hold in the health and medical communities: audio-visual communication, mass media campaigns, and advocacy. Initiatives were introduced into prisons and other institutions.

Though health education skill and competence requirements clearly were ever-changing depending upon the health issues of the time, the 1978 Health Education Role Delineation Project set out to identify core health education responsibilities. Following the role verification profess and the national Conference for Institutions Preparing Health Educators in Birmingham, AL in 1981, the Framework for the Development of Competency-Based Curricula for Entry-Level Health Educators was published in 1985. The framework outlined seven areas of entry-level responsibilities for health education specialists, including 79 sub-competencies. The framework gave direction and focus to the professional preparation of health educators and was supported by a new national health education specialist certification exam first administered in 1990.

Everyone (not just people who have been fired or fear they are about to be) reinvents themselves personally and professionally at some time or other…deliberately or inadvertently, strategically or impetuously. In fact, the author argues that professional reinvention is not only a good defense, but a great offense, pointing out how reinvention can help you take charge of your life as well as accommodate new work world realities. To support and encourage professional reinvention, the author couches the value of being able to transform yourself professionally in the context that health education itself is a profession that is constantly reinventing itself. The article includes a definition of reinvention and discussions about who reinvents themselves and when and why, and stories of six health educators and how they reinvented themselves. The article ends with suggested reinvention pre-requisites to foster successful work life transitions and transformations, and a list of ten tips for successful professional reinvention(s).

Do You Dare?
If you’re thinking, “Hey, I don’t need to read this. I’ve never been fired and I won’t ever get fired,” here are three important news flashes. One: if you’re going to survive and thrive in your personal life as well as in your work life, you need to be able to reinvent yourself. Two: reinvention is something you are doing all the time already, just unconsciously; so consciously can only help. Three: there’s a pretty good chance you will get fired, merged into unemployment, urged into early retirement, or purged in a lay off somewhere along the line ― and so what? You’ll survive. I did!

Writing this article is part of my nth professional reinvention ― this time as a “Career Development Lifeguard” ― after 40 years of work experience…since high school. That experience includes four so-called “careers” (a term I find too confining) in my work life, 15 full-time jobs, and dozens of part-time jobs. Therefore, I have not only become a fervent believer in personal and professional reinvention, I have become a staunch advocate of it!

As a health education specialist who is also certified as a senior professional in human resources, I am eager to present the concept of reinvention ― or worklife reincarnation, if you will ― within a career development context and its value as a core career development skill – right up there with strategic thinking, creativity, problem solving, writing and speaking skills, and so on. We will explore what it means to “reinvent yourself”, how you might reinvent yourself, and when you might do so. In short, we will discuss how being able to reinvent yourself ― once, twice, or as many times as professionally politic or personally pleasing ― can be a key to your success.

Discussion
As hypothesized, more clinical skills are needed to secure health education positions in the clinical setting. Most respondents felt a CHES certification was beneficial to their positions. When asked what heath educators could do to “sell” themselves to prospective employers, 60% (n=15) said demonstrating knowledge of health education, program planning, program implementation, evaluation and grant writing were the best skills to have to sell themselves. In addition, being able to communicate or explain what health educators can do for a company was answered by 24% (n=6) of the respondents. Twelve percent (n=3) said to research the company and find out how you can meet their needs. One respondent (4%) suggested taking examples of work done from internships and classes such as brochures, PowerPoint® presentations, display boards, and other works to show the prospective employer. When asked about other course work they would recommend in terms of academic preparation to be a health educator in a clinical setting, 24% (n=6) said clinical physiological testing skills were important to know. Twelve percent (n=3) said volunteer experience in a clinical setting was important, marketing and sales courses, communication classes and education courses would be helpful. Counseling or social work courses, medical terminology and nutrition courses were the answer given by 8% (n=2) of the respondents of courses helpful in preparation of a career as health educators.

What do these results mean for the profession of health education? If upon graduation, health education students want to work in the clinical setting, they must make good choices on how to choose their elective courses. The courses they choose should emphasize clinical skills, communication, education, marketing, counseling, medical terminology, and nutrition. They should also have volunteer experience in a clinical setting, and choose to complete an internship in a clinical setting. After graduation, when trying to gain employment in a clinical setting, they need to be able to demonstrate the knowledge they possess, the experiences they have gained and demonstrate what they can offer to prospective employers. Many employers do not know very much about health education graduates and need to be educated to the benefits of hiring a health educator to fill clinical positions.

This study was not without its limitations. The greatest limitation was the selection of the participants. The snowball sampling technique was used because resources were limited and a probability sample was too costly and time consuming to complete. Non-probability samples have limitations because results can only be generalized to those who participated. Bias may occur since those who are not included in the sample may differ in ways from those who are included in the sample (McKenzie et al., 2005).

Conclusions
In conclusion, additional studies on health educators working in the clinical setting need to be completed to gain a better understanding of the profession. Leaders of organizations who employ people in clinical settings need to have a better understanding of what health educators are doing and the potential they can bring to an organization. In order to change the mind-set of many who feel that only those with clinical training should do patient education creates a great obstacle, which needs to be overcome. Only with more information available and continued monitoring of credentialing to provide a set of standards for health educators, can attitudes be changed and gains be made in the area of health educators working in a clinical setting.

Sixty-two point five percent (n=25) of health educators who were invited to participate in the study did so by either answering the questionnaire verbally over the telephone or completing a questionnaire and returning it by email. These 25 individuals worked for 12 different agencies. Of the agencies and organizations employing the participants in the study, most 75% (n=9) of these agencies were not-for-profit organizations. Of those who participated, 98% (n=23) were females and 44% (n=11) were CHES certified. Another 16% (n=4) reported to have taken the exam and were awaiting results at the time this survey was conducted.

When participants were asked about their job title, 15 different job titles were given. Sixty-eight percent of the respondents (n=17) reported the number of health educators on staff was between one and five. When the respondents were asked about their major job responsibilities, community education was the most reported response, followed by management, teaching nutrition/fitness, patient education, scheduling, program planning, coordination of planning, being a community liaison, and supervision.

A number of questions were asked about the services provided by the health educators and their agencies. Eighty-four percent (n=21) offered public education. Seventy-two percent (n=18) offered employee education, and 64% (n=16) offered patient education programs. There were 88% (n=22) who reported attending health fairs, with 72% (n=18) who attended less than 19 per year. When asked if they charged for health education programs, 64%, (n=16) did not charge. Yet, 68% (n=17) of the respondents reported they relied on grant dollars for program funding. Of those who relied on grant funding, 28% (n=7) of the respondents reported 90-100% of their budget was grant funded.

When asked with what agencies they worked most closely, 44% (n=11) worked with voluntary agencies, 36% (n=9) worked with schools, 36% (n=9) work with local health departments, 16% (n=4) work with county tobacco coalitions, 12% (n=3) with hospitals, state health departments, churches or religious organizations, and health centers, 8% (n=2) with state agencies, and less that 4% (n=1) worked with city government, centers for aging, YMCA, community agencies and federal agencies.

One hundred percent of the respondents reported offering activities outside the clinical setting (also known as outreach programs). In these outreach programs, 80% (n=20) used printed materials, 76% (n=19) offered educational programs, and 60% (n=15) offered free health screenings. Most respondents (80%, n=32) reported that their agency paid for materials instead of getting donations for materials or creating their educational materials in-house.

Several questions were asked about the Certified Health Education Specialist (CHES) credential. Most of the respondents, 72% (n=18) felt the CHES certification was helpful in their positions. There were 56% (n=14) who said the CHES certification was necessary to sell themselves to potential employers. Only 16% (n=4) of the respondents felt a CHES certification was not necessary in their positions.

Participants
The participants in this study were selected using a snowball sample. A snowball sample includes those identified by the researchers and others referred by initial participants (McKenzie, Neiger, & Smeltzer, 2005). In this study the researchers initially identified 20 potential participants. These individuals were called and invited to participate in the study. If they agreed, they were interviewed. At the conclusion of the interview, they were asked to give the name(s) of other health educator(s) working in Indiana in a clinical setting, thus, the snowballing of the sample. A total of 40 individuals were contacted using this process with 25 (62.5%) willing to participate.

Instrumentation
An original questionnaire was created to identify the roles and responsibilities of health educators from Indiana working in clinical settings. Perhaps the most challenging aspect of developing a useful instrument was deciding what information was needed to better understand health educators and their roles in the clinical setting. The researchers developed an initial pool of 20 questions for the instrument. A review of the questions by a university professor was used to establish face validity. Content validity was established using a jury of experts. The jury was composed of six health educators working in a clinical setting. After the jurors agreed to participate, they were emailed a letter explaining the purpose of the instrument, a draft of the instrument and instructions for completing three tasks. First, they were asked to read each question and to make suggestions for making any unclear questions better. Second, they were asked to offer suggestions or new questions they thought should be included in the instrument. And third, each was asked to rate the questions as either essential, useful but not essential, or not necessary. Upon receipt of the jurors’ work, unclear items were rewritten, and some questions were deleted and added. The final instrument contained 24 questions.

Data Collection
Data were collected via a telephone or email survey. When the subjects were contacted by telephone, they were asked if they would be willing to participate in a survey about health educators working in a clinical setting. If so, they were interviewed then or at another convenient time. If the subjects felt uncomfortable about being interviewed by telephone, or did not have time for a telephone interview, the questionnaire was emailed to them for completion. Of the 25 completed questionnaires, two (8%) were completed via telephone and 23 (92%) were completed via email.

Upon receipt of each completed questionnaire, each was coded and the data were transferred to a computer scan form. Data analysis included tabulation of frequencies and percentages.

This study examined the task of health educators working in a clinical setting to better understand their roles. The study was designed as a descriptive, cross-sectional survey using a convenience sample of health educators who worked in clinical settings in Indiana and who had a college degree in health education. Forty health educators were contacted and 62.5% of the subjects participated in the survey. Results indicated most jobs were similar in nature and the health education curriculum studied helped them in the roles they were serving. However, many educators felt there were other content areas of study that would have been helpful to prepare them for working in the clinical setting. A majority of the respondents reported that having Certified Health Education Specialist (CHES) certification was helpful and necessary in their positions.
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Introduction
The process to define the role of a health educator began in 1978. By 1981, the generic role was defined. Shortly thereafter came the writing of the Competency-Based Framework for the Professional Development of Certified Health Education Specialist (National Commission for Health Education Credentialing, Inc. [NCHEC], 1996). Recent challenges in public health since September 11, 2001, have highlighted the role of health educators and research has described its supply, geographic distribution, educational preparation and desired competencies (Finacchio, Love, & Sanchez, 2003).

Even though there appears to be a need for health educators, and we profess to prepare generic health educators, some have questioned whether it is possible to do so because of the peculiarities of each setting (McKenzie, 2004). Examples of such peculiarities include the culture in the business world (work site setting), and the language used in health care (clinical setting). Because of some of these peculiarities, it has been very difficult for health educators to secure health education positions in the clinical setting. Employers have been more inclined to hire individuals with clinical training than health educators for health education positions in the clinical setting. While the work of health educators in community health settings is well understood, very little information has been written on this subject of health educators working in the clinical setting. Therefore, the purpose of this study was to find out more about the work of health educators in the clinical setting. This information would not only be helpful to new health educators seeking employment in a clinical setting, but also to healthcare organizations that could benefit from employing health educators.