Health education: new opportunities for pediatric practice: the pioneering use of a health educator has helped this small, rural pediatric practice realize its medical mission and its business goals. The clinic's experience, the authors assert, can be applied anywhere.

Traditionally, health educators have been employed to provide information in city, county, and state health departments; schools; work-site health and wellness programs; and voluntary agencies such as the American Cancer Society. Today, they are finding their way into the health-care delivery system into hospitals and health maintenance organizations and, occasionally, into private group practices. (1-3) This article describes the evolving role of a health educator in a private three-physician pediatric practice in a rural prairie community in Nebraska.

Who are health educators?

Health education is a newly recognized nonmedical specialty. (4) Health educators typically hold at least a bachelor's degree in health education and have passed a nationally recognized examination to become a certified health education specialist (CHES). (5) Their salary ranges from $32,000 to $37,000 a year. (6)

Health educators have, as noted, traditionally focused on providing information. Today, they design activities specifically to encourage changes in behaviors that will ultimately improve and protect health, either by making treatment more effective or reducing behaviors that could lead to future health problems. Health educators develop educational programs aimed either directly at effecting behavior change or indirectly at changing the environment in ways that reduce risks and promote and support behavior change.

The setting

Hastings, Nebraska, and the surrounding county has a population of 30,000. Like many rural places, the county has no public health department. The health needs of children and adolescents there are met by pediatricians in a private practice clinic and by three family practice clinics. The private pediatric practice serves approximately 16,000 families.

Twelve years ago, the pediatric clinic hired a halftime health educator to help meet patient needs and bring a public health perspective to the clinic and the community. Today, the health educator is responsible for a range of activities that are recognized as essential to the clinic and the community. This experience could, we believe, be replicated almost anywhere.

First step: Surveying needs and interests

Health educators are trained to identify health service and information needs and interests of a population. (7) One of the first projects undertaken by the pediatric clinic's health educator was to conduct a survey to identify the perceived needs and interests of the clinic's clients. It was distributed by the clinic staff to families as they checked in for their appointment In addition to health-related questions, the survey asked about such matters as reasons for choosing the clinic, preferred appointment times, and the choice of magazines in the waiting room.

Results of the interest survey indicated that families came to the clinic "for its reputation"; that many wanted appointments late in the afternoon; and that they appreciated the reading materials in the waiting room. Many families suggested a separate waiting room for children and adolescents. The clinic was reorganized to address responses to the survey, and patient satisfaction improved. Why probe the connection between satisfaction and the quality of care? Research suggests that satisfied patients are more likely to adhere to treatment regimens and seek early help when a...