Key environmental health competencies for rural primary care providers

Background: Providing rural primary care that considers environmental determinants of health and environmental impact on health is complex, as providers need to be competent in social and health sciences as well as environmental health concepts. This study developed, via expert consensus and validation, a guide of essential environmental health competencies for rural primary care providers. Methodology: After evaluation of existing competencies from a variety of disciplines, a national consensus conference was convened to develop key competencies. Ten experts from environmental, public, and rural health and specific primary care disciplines participated. A draft of the competencies emerged from this conference. The competencies were tested for clarity, content validity and applicability via an online survey released to expert stakeholders in environmental and rural health, and primary care. Respondents answered questions relating to the clarity, content, and applicability of each competency. Results: All but 10 competencies reached greater than 85% agreement on all questions among the survey respondents. Those below 85% agreement were reviewed and adjusted by the ten experts who developed the competencies. Policy Implications: National organizations which delineate practice competencies should adopt the results of this work for inclusion in entry level rural primary care education programs. Accreditation bodies for programs preparing rural primary care providers may reflect these competencies as essential elements of those programs. Professional organizations that support rural primary care can contribute to the development of these competencies in the workforce through integration into future professional education programs.