Building the future of public health in Canada: A modified Delphi survey for updated core competencies

The process of updating the Core Competencies for Public Health in Canada, Release 1.0, was initiated in 2023 using a multi-method approach. This included evidence syntheses, an extensive engagement process to ensure relevance to current public health challenges and a Delphi survey. The objective of this study was to assess agreement on the updated competency statements among a diverse range of public health professionals, educators, policymakers, and community representatives across Canada.

A modified Delphi survey was conducted in English and French to assess agreement with 68 draft competency statements across 10 categories. Eligible participants were members of the Canadian public health community who were 18 years of age or older and able to participate in either official language. Participants rated their agreement with each statement using a 6-point Likert scale, with an a priori agreement threshold set at 70%. Agreement was defined as the number of participants who responded with 'agree' or 'strongly agree' to a statement, with a predefined threshold set at 70%. Open-ended text boxes allowed for qualitative feedback, which was analyzed thematically.

High agreement was achieved across all competency categories and statements, with a mean agreement level of 86.1% and an average of 551 responses per statement. The highest agreement was found in the Communication category (mean agreement of 91.5%), while the Public Health Advocacy category had the lowest agreement (79.5%). Participants expressed strong support for the inclusion of new categories and updated statements not present in Release 1.0, particularly those emphasizing social justice, technology, and advocacy. Thematic analysis revealed widespread appreciation for the update and its enhanced focus on social justice, health equity, and Indigenous inclusion, alongside concerns about tailoring expectations based on professional roles and experience.

The high agreement obtained from a diverse cross-section of stakeholders affirms the relevance of the revised categories and statements to contemporary and future public health practice. These findings supported the finalization of the Core Competencies for Public Health in Canada, Release 2.0. Ongoing efforts will focus on engaging knowledge user groups and embedding the competencies into workforce planning, development, education, and training.