Area I: Assessment
17%of exam
Primary DataSecondary DataEpidemiology RatesCommunity NeedsNeeds Assessment
Area II: Planning
14%of exam
PRECEDE-PROCEEDBehavior TheoriesSMART ObjectivesLogic ModelsAction Plans
Area III: Implementation
15%of exam
Program DeliveryPilot TestingCurriculum FidelityPhase-In Rollout
Area IV: Evaluation and Research
12%of exam
Formative EvaluationSummative EvaluationImpact vs OutcomeEvaluation DesignsInternal Validity
Area V: Advocacy
12%of exam
Policy AdvocacyCoalition BuildingGrassroots MobilizationLegislative Action
Area VI: Communication
12%of exam
Health LiteracyPlain LanguageTeach-Back MethodCultural Competence
Area VII: Leadership and Management
6%of exam
Partner CapacityResource ManagementVolunteer TrainingStrategic Coordination
Area VIII: Ethics and Professionalism
12%of exam
Code of EthicsRecertification RulesInformed ConsentProfessional Boundaries
Quick Facts
- Exam
- CHES
- Body
- NCHEC
- Questions
- 165 total questions
- Scored Items
- 150 scored, 15 pilot
- Exam Time
- 3 hours testing
- Passing Score
- 600 scaled score
- Score Scale
- 200 to 800 range
- Blueprint
- Eight Areas of Responsibility
- Recertification
- 75 CECH every 5 years
- Delivery
- PSI test center or remote
- Current Outline Applies
- Through Fall 2026 administration
- Spring 2027: nine areas
- 175: 150 scored + 25 pilot
Incidence vs Prevalence
Incidence
- New cases during period
- Measures risk of disease
- Uses population at risk
Prevalence
- All existing current cases
- Measures total disease burden
- Represents cross-sectional snapshot
New cases vs total burden
Needs Assessment Method Picker
- Anonymous expert consensus across rounds→Delphi Technique(Iterative questionnaire rounds)
- Guided interactive small group discussion→Focus Group Interview(6 to 10 participants)
- Community-wide representative population survey→Probability Sampling Survey(Generalizable local findings)
- Community members photograph local needs→Photovoice Method(Participatory visual assessment)
- Analyzing existing public health surveillance→Secondary Data Review(CDC BRFSS or YRBS)
- Cataloging community physical economic assets→Community Asset Mapping(Inventory local strengths)
Epidemiology Rates and Measures
- Incidence Rate
- New cases divided by person-timeRate
- Incidence Proportion
- New cases / initially disease-free populationRisk
- Prevalence Proportion
- Existing cases / specified-time populationBurden
- Relative Risk
- Exposed risk divided by unexposedCohort
- Odds Ratio
- Case exposure odds versus controlsCase-Control
- Attack Rate
- Cumulative incidence in acute outbreakOutbreak
- Crude Mortality Rate
- Deaths / population during stated periodVital
- Infant Mortality Rate
- (Infant deaths/live births) × 1,000Vital
Primary vs Secondary Data
Primary
- Original data collected firsthand
- Tailored to specific questions
- Requires more time money
Secondary
- Pre-existing surveillance reports
- Rapid access lower cost
- May lack exact fit
Firsthand data vs existing records
PRECEDE Assessment Phases
Social -> Epi -> Educational -> Admin
Phase 1: Social assessmentPhase 2: Epidemiological assessmentPhase 3: Educational factorsPhase 4: Administrative policy
Impact vs Outcome Objectives
Impact
- Short-term behavioral change
- Assesses immediate knowledge gains
- Measures skill development
Outcome
- Long-term health status changes
- Measures morbidity and mortality
- Assesses quality of life
Intermediate actions vs ultimate health
Behavior Change Theory Picker
- Individual weighs health disease threat→Health Belief Model(Perceived threat and benefits)
- Client readiness transitions across stages→Transtheoretical Model(Stage tailored interventions)
- Social norms drive behavioral intentions→Planned Behavior Theory(Perceived behavioral control)
- Observational modeling and self-efficacy→Social Cognitive Theory(Reciprocal environmental determinism)
- Innovation spreads through social system→Diffusion of Innovations(Target early adopters first)
- Multi-level policy and community changes→Socio-Ecological Model(Intervene across all layers)
- Client attributes health to luck→External Locus Control(Strengthen internal agency)
- Community dialogue solves shared oppression→Freirian Adult Education(Builds critical consciousness)
PRECEDE-PROCEED Model Phases
- Phase 1: Social
- Community quality of life assessmentPRECEDE
- Phase 2: Epidemiological
- Health problems and behavioral factorsPRECEDE
- Phase 3: Educational
- Predisposing reinforcing and enabling factorsPRECEDE
- Phase 4: Administrative
- Assess administrative and policy capacityPRECEDE
- Phase 5: Implementation
- Deliver program interventions activelyPROCEED
- Phase 6: Process
- Assess program delivery and fidelityPROCEED
- Phase 7: Impact
- Evaluate immediate behavioral environmental changesPROCEED
- Phase 8: Outcome
- Evaluate long-term health status changesPROCEED
SMART Objective Formula
Specific Measurable Achievable Relevant Time-Bound
Specific: exact target groupMeasurable: numeric metric targetAchievable: attainable program scopeRelevant: aligned with health prioritiesTime-Bound: specified target date
Behavior Change Theories
- Health Belief Model
- Perceived threat and self-efficacyIndividual
- Transtheoretical Model
- Stages of intentional behavior changeStages
- Theory of Planned Behavior
- Attitudes subjective norms behavioral controlCognitive
- Social Cognitive Theory
- Reciprocal determinism and observational learningInterpersonal
- Diffusion of Innovations
- Adopter categories and innovation spreadCommunity
- Socio-Ecological Model
- Multi-level environmental determinants of healthEcological
- Locus of Control
- Internal versus external health attributionAttribution
TTM Change Stages
Precontemplation -> Contemplation -> Preparation -> Action -> Maintenance
Precontemplation: no change intentContemplation: considering changePreparation: planning initial stepsAction: modifying observable behaviorMaintenance: sustaining change habits
SMART Objective Components
- Specific
- Defines target population and settingWho
- Measurable
- Quantifies expected numeric baseline changeHow Much
- Achievable
- Realistic given program resource limitsFeasible
- Relevant
- Aligned with identified goals and needsRelevant
- Time-Bound
- Specifies exact deadline for completionWhen
- Process Objective
- Specifies program implementation activity targetsExecution
- Impact Objective
- Specifies intermediate behavior knowledge targetsIntermediate
- Outcome Objective
- Specifies long-term health disease targetsUltimate
Educational Assessment Factors
Predisposing -> Enabling -> Reinforcing
Predisposing: knowledge attitudes valuesEnabling: resources skills accessReinforcing: family peers rewards
Implementation and Delivery Controls
- Implementation Plan
- Activities, owners, schedule, resources, milestones
- Pilot Delivery
- Test feasibility before wider rollout
- Fidelity
- Deliver essential intervention components consistently
- Adaptation
- Document context changes; preserve core functions
- Staff Training
- Practice delivery and check readiness
- Reach
- Proportion of intended population participating
- Implementation Monitoring
- Compare actual delivery with planned activities
Formative vs Summative Evaluation
Formative
- Conducted during program development
- Pilot tests instructional materials
- Refines ongoing program delivery
Summative
- Conducted after program completion
- Measures overall program effectiveness
- Judges final program merit
Refine delivery vs judge results
Evaluation Design Picker
- Pretesting educational materials before launch→Formative Evaluation(Refines instructional content)
- Monitoring program attendance and fidelity→Process Evaluation(Tracks implementation quality)
- Assessing immediate knowledge skill gains→Impact Evaluation(Short-term behavioral change)
- Measuring long-term disease reduction→Outcome Evaluation(Morbidity and mortality changes)
- Random assignment to control group→Experimental RCT Design(Controls internal validity threats)
- Using intact non-random comparison groups→Quasi-Experimental Design(No random assignment to conditions)
- Single group posttest only evaluation→Non-Experimental Design(Lowest internal validity)
- Comparing program costs against effects→Cost-Effectiveness Analysis(Cost per health unit)
Evaluation Types and Designs
- Formative Evaluation
- Pilot tests materials during developmentPre-Launch
- Process Evaluation
- Monitors program delivery and fidelityDelivery
- Impact Evaluation
- Measures immediate behavioral knowledge gainsShort-Term
- Outcome Evaluation
- Assesses long-term mortality morbidity reductionsLong-Term
- Experimental Design
- Random assignment with control groupRCT
- Quasi-Experimental Design
- Comparison groups without random assignmentNon-Random
- Internal Validity
- Confidence that intervention caused outcomeAttribution
- External Validity
- Generalizability across settings and populationsBreadth
Internal vs External Validity
Internal
- Intervention caused observed change
- Controls for confounding variables
- High control laboratory settings
External
- Generalizes to other populations
- Applies across diverse settings
- Real-world program effectiveness
Causal truth vs generalizability
Advocacy and Policy Change
- Media Advocacy
- Strategic news coverage shaping policyMedia
- Grassroots Lobbying
- Rallies general public contacting legislatorsPublic
- Direct Lobbying
- Communicates directly with legislative officialsLegislative
- Coalition
- Alliance of diverse partner organizationsPartnership
- Policy Brief
- Concise decision summary for policymakersDocument
- Legislative Champion
- Elected official leading policy enactmentLeadership
- Health in All Policies
- Integrates health considerations across policy sectorsFramework
Health Literacy and Communication
- Health Literacy
- Capacity to process health informationDefinition
- SMOG Formula
- Calculates reading grade from polysyllablesFormula
- Flesch-Kincaid
- Computes readability grade using syllablesFormula
- Teach-Back Method
- Prompts clients to explain conceptsValidation
- Plain Language
- Writing understandable at first readingClarity
- Universal Precautions
- Structuring materials clearly for allStrategy
- Cultural Competence
- Respecting diverse cultural health beliefsEquity
- Photovoice
- Community documentary participatory photography methodParticipatory
Leadership and Management Controls
- Program Budget
- Match activities with costs and resources
- Grant Requirements
- Track allowable costs and reporting deadlines
- Personnel Roles
- Assign responsibility, authority, support, accountability
- Partnership Agreement
- Clarify shared goals, roles, contributions
- Conflict Resolution
- Identify interests; negotiate workable agreements
- Quality Improvement
- Use performance data for iterative improvements
- Resource Stewardship
- Document decisions and protect entrusted resources
Category I vs Category II CECH
Category I
- Pre-approved designated provider events
- Requires 45 credits minimum
- Permits rollover up to 15
Category II
- Non-approved professional activities
- Capped at 30 credits
- No rollover permitted
Pre-approved credits vs unapproved activities
Code of Ethics Principles
- Article I: Core Expectations
- Honesty, autonomy, beneficence, respect, justice2020 Code
- Article II, Section I
- Public health, rights, autonomy, equityPublic
- Article II, Section II
- Competence and ethical professional conductProfession
- Article II, Section III
- Ethical conduct with colleagues and employersEmployers
- Article II, Section IV
- Inclusive, evidence-informed health education deliveryDelivery
- Article II, Section V
- Lawful, ethical research and evaluationResearch
- Article II, Section VI
- Ethical professional preparation and continuing educationEducation
Recertification and CECH Rules
- Recertification Cycle
- Five years per certification cycleRule
- Total Credits
- 75 total CECH credits requiredRequirement
- Category I CECH
- Minimum 45 pre-approved credits requiredMandatory
- Category II CECH
- Maximum 30 unapproved credits permittedCap
- Continuing Competency
- Five credits required within totalSub-Requirement
- Category I Carryover
- Up to 15 excess creditsRollover
- Annual Maintenance
- Renew annually; verify current published feeAnnual
- Outside Continental US
- Category II exception; competency assessment retainedException
Spring 2027 HESPA III Transition
- Effective Administration
- Spring 2027 replaces eight-area 2026 outline
- Item Format
- 175 total; 150 scored, 25 pilot
- Assessment / Planning
- 15% each under HESPA III
- Implementation / Evaluation
- 12% implementation; 15% evaluation
- Research / Advocacy
- 3% research; 12% advocacy
- Communication / Administration
- 13% communication; 5% administration
- Ethics, Leadership, Professionalism
- 10% under the nine-area outline
Common Traps
Incidence vs Prevalence
Incidence measures new cases ≠ Prevalence measures existing cases
Impact vs Outcome
Impact reflects intermediate changes ≠ Outcome reflects long-term health
Formative vs Summative
Formative guides program improvements ≠ Summative evaluates final results
Reliability vs Validity
Reliability ensures measurement consistency ≠ Validity ensures true construct
Primary vs Secondary Data
Primary collected for the study purpose ≠ Secondary reuses existing datasets
Category I vs Category II
Category I requires pre-approval ≠ Category II unapproved activities
Last Minute
- 1.165 questions; 150 scored items
- 2.600 scaled pass on 200–800
- 3.Incidence = new; Prevalence = existing
- 4.Formative = improve; Summative = judge
- 5.Impact = behavior; Outcome = health
- 6.SMART = measurable evaluation target
- 7.Teach-Back = verify patient comprehension
- 8.Category I = pre-approved credits
- 9.SMOG = grade readability formula
- 10.Precontemplation = no change intent
Free CE
Buy on Amazon
Flashcards on Mometrix
Practice exams on ExamEdgeSame family resources
Explore More NCHEC Health Education Certifications
Continue into nearby exams from the same family. Each card keeps practice questions, study guides, flashcards, videos, and articles in one place.
More From This Family
Videos and articles for deeper review.