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CHES practice questions

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Question 1Assessment of Needs and Capacity

A community health assessment team wants to use secondary data. Which of the following is an example of a secondary data source?

  1. Focus group transcripts collected for this assessment
  2. Census Bureau population estimates Correct answer.
  3. A survey the team administered to residents
  4. Key informant interviews conducted by the team

Explanation

Secondary data already exist because another party gathered them for a different purpose, so the team simply retrieves and analyzes them. Census Bureau estimates fit that definition, while the other three sources are generated firsthand by the assessment team and are therefore primary data.

Question 2Assessment of Needs and Capacity

Which data collection method is best suited to exploring community members' perceptions in their own words?

  1. Review of vital statistics
  2. Closed-ended mail survey
  3. Focus group discussion Correct answer.
  4. Geographic information system mapping

Explanation

Qualitative methods such as focus groups let participants describe experiences and opinions using their own language and allow the moderator to probe for depth. The other options yield numeric or predefined responses that cannot capture rich narrative detail.

Question 3Assessment of Needs and Capacity

In a simple random sample, each member of the population has which of the following?

  1. An equal chance of being selected Correct answer.
  2. A chance proportional to their level of risk
  3. An opportunity to volunteer for the study
  4. Selection based on the researcher's judgment

Explanation

Simple random sampling gives every member of the defined population an equal and independent probability of selection, which supports generalizability. Methods that depend on risk level, volunteering, or researcher judgment introduce nonrandom selection.

Question 4Assessment of Needs and Capacity

The primary purpose of a community health needs assessment is to do which of the following?

  1. Evaluate the job performance of existing program staff
  2. Measure how far a completed program reached residents
  3. Identify and prioritize the health needs of a population Correct answer.
  4. Determine the annual operating budget for the agency

Explanation

A needs assessment systematically gathers data to describe the health status, assets, and gaps of a defined population and then ranks those needs for action. Staff evaluation, budgeting, and reach measurement are evaluation and management tasks rather than needs identification.

Question 5Assessment of Needs and Capacity

Which national data system provides state-level prevalence estimates for behavioral risk factors such as tobacco use and physical inactivity?

  1. National Vital Statistics System natality files
  2. National Health Interview Survey household data
  3. Behavioral Risk Factor Surveillance System Correct answer.
  4. Uniform Crime Reporting Program data files

Explanation

The Behavioral Risk Factor Surveillance System is a state-based telephone survey that produces state and local estimates of health behaviors and preventive service use. The other sources track births, crime, or nationally representative household health interviews rather than state-level behavioral prevalence.

Question 6Assessment of Needs and Capacity

Which element is essential in the informed consent process for a needs assessment survey?

  1. The researcher's home address and telephone number
  2. The participant's social security number and birth date
  3. A promise of payment for every respondent
  4. A statement that participation is voluntary Correct answer.

Explanation

Informed consent must disclose that participation is voluntary and may be withdrawn without penalty, along with purpose, risks, and protections. Collecting identifying numbers or promising payment is not required and can create unnecessary risk or undue influence.

Question 7Assessment of Needs and Capacity

Which type of scale asks respondents to indicate agreement along a continuum from strongly agree to strongly disagree?

  1. Nominal scale
  2. Ratio scale
  3. Guttman scale
  4. Likert scale Correct answer.

Explanation

A Likert scale presents a statement with ordered response choices expressing degree of agreement, and the resulting data are treated as ordinal. Nominal scales label categories without order, ratio scales have a true zero, and Guttman scales order items by cumulative intensity rather than agreement.

Question 8Assessment of Needs and Capacity

In a logic model, outputs are best described as which of the following?

  1. The assumptions underlying the program design
  2. The direct products of program activities Correct answer.
  3. The long-term health changes a program expects
  4. The resources a program invests in its work

Explanation

Outputs are the countable products of activities, such as sessions delivered or screenings completed. Inputs are the resources, outcomes are the changes expected, and assumptions are the beliefs the model rests on.

Question 9Assessment of Needs and Capacity

A researcher selects every tenth name from an alphabetized list of clinic patients. Which sampling method is being used?

  1. Stratified sampling
  2. Cluster sampling
  3. Purposive sampling
  4. Systematic sampling Correct answer.

Explanation

Systematic sampling applies a fixed selection interval to a listing of the population after a random start. Cluster and stratified sampling divide the population into groups first, and purposive sampling relies on deliberate judgment.

Question 10Assessment of Needs and Capacity

Which survey question is least likely to bias respondents' answers?

  1. How often did you visit the park last month? Correct answer.
  2. How many times did you fail to use the new park?
  3. Why do you support expanding the park?
  4. Don't you agree the new park is a great idea?

Explanation

Neutral wording asks about behavior without implying a preferred answer or presupposing a position. Leading questions, presuppositional questions, and questions that frame nonuse as failure all push respondents toward a particular response.

Question 11Assessment of Needs and Capacity

When a planning group sets priorities among identified community needs, it should weigh which of the following?

  1. The preferences of the lead funding agency alone
  2. Severity, scope, and feasibility of change Correct answer.
  3. The number of people affected and nothing else
  4. The cost of the planned intervention alone

Explanation

Priority setting considers the magnitude and seriousness of each problem plus whether an effective response is achievable with available resources. Relying on a single criterion such as cost, prevalence, or funder preference produces a defensible-sounding but incomplete ranking.

Question 12Assessment of Needs and Capacity

Key informant interviews are most appropriate when the purpose is to do which of the following?

  1. Test the internal reliability of a survey
  2. Measure the incidence of a disease over time
  3. Gain in-depth views from knowledgeable people Correct answer.
  4. Produce statistically representative population estimates

Explanation

Key informants are selected purposively for their position or experience, so interviews yield rich insight rather than population estimates. Representativeness, disease incidence, and instrument reliability require probability sampling or structured measurement.

Question 13Assessment of Needs and Capacity

An asset map differs from a traditional needs assessment because it focuses on which of the following?

  1. Strengths and resources already in the community Correct answer.
  2. Gaps in services and the unmet needs of residents
  3. Mortality rates among community residents
  4. Cost of launching new programs in the area

Explanation

Asset mapping inventories the skills, organizations, facilities, and relationships a community already possesses as a foundation for action. Deficit-oriented questions about gaps, death rates, and program costs belong to conventional needs identification.

Question 14Assessment of Needs and Capacity

A mailed survey is sent to 400 households and 100 completed surveys are returned. What is the response rate?

  1. 25% Correct answer.
  2. 40%
  3. 75%
  4. 4%

Explanation

Response rate equals completed returns divided by questionnaires delivered, multiplied by 100. Here 100 divided by 400 equals 0.25, or 25 percent.

Question 15Assessment of Needs and Capacity

Examining the same health issue through focus groups, a household survey, and vital statistics records is an example of which of the following?

  1. Triangulation Correct answer.
  2. Extrapolation
  3. Randomization
  4. Standardization

Explanation

Triangulation combines multiple methods or data sources to see whether findings converge, which strengthens confidence in conclusions. Randomization and standardization concern sampling and measurement procedures, and extrapolation projects findings beyond the data.

Question 16Assessment of Needs and Capacity

An assessment team translates a survey into another language and then has a second translator render it back into the original language. This is done mainly to do which of the following?

  1. Guarantee that the sample is random
  2. Reduce the time needed to administer it
  3. Increase the size of the sample
  4. Check that meaning is preserved in translation Correct answer.

Explanation

Back-translation reveals places where nuance or connotation shifted, so the team can revise items before fielding. It addresses cultural and linguistic equivalence of the instrument, not sampling or administration logistics.

Question 17Assessment of Needs and Capacity

During a needs assessment, a capacity assessment is used to determine which of the following?

  1. Number of new cases occurring each year
  2. Prevalence of the highest-priority health condition
  3. Resources and skills available to address the needs Correct answer.
  4. Size of the target population

Explanation

Capacity assessment inventories the organizations, workforce, funding, partnerships, and infrastructure a community can mobilize. Prevalence, incidence, and population size describe the problem itself rather than the ability to respond to it.

Question 18Assessment of Needs and Capacity

A windshield survey is conducted primarily to do which of the following?

  1. Randomly select participants for a survey
  2. Calculate age-adjusted death rates
  3. Collect hospital discharge records for residents
  4. Observe a community's physical environment Correct answer.

Explanation

A windshield survey is structured direct observation of housing, roads, food outlets, signage, and other visible features that shape health. It generates observational impressions rather than clinical records, rates, or probability samples.

Question 19Assessment of Needs and Capacity

In the PRECEDE-PROCEED model, epidemiological, behavioral, and environmental factors affecting health status are examined in which phase?

  1. Phase 5, implementation
  2. Phase 1, social assessment
  3. Phase 2, epidemiological assessment Correct answer.
  4. Phase 4, administrative and policy assessment

Explanation

Phase 1 identifies social problems and quality-of-life concerns, and Phase 2 then pins down which health problems and behavioral or environmental determinants underlie them. Administrative and policy assessment and implementation come later in the model.

Question 20Assessment of Needs and Capacity

An instrument produces nearly identical scores each time it is administered, but it does not measure the construct it was intended to measure. The instrument lacks which of the following?

  1. Feasibility
  2. Validity Correct answer.
  3. Reliability
  4. Sensitivity

Explanation

Validity is the extent to which an instrument measures what it claims to measure, so consistent but off-target scores indicate a validity problem. Reliability concerns consistency, sensitivity concerns detecting true differences, and feasibility concerns practical administration.

Question 21Assessment of Needs and Capacity

A needs assessment recruits participants at a farmers market on weekday mornings. The main threat to generalizing the findings to the whole community is which of the following?

  1. Recall bias among older respondents in the sample
  2. Selection bias from a nonrepresentative sample Correct answer.
  3. Interviewer fatigue during data collection
  4. Social desirability in self-reported answers

Explanation

People who shop at a farmers market on a weekday morning differ systematically from the broader population in income, employment, age, and health behavior, so the sample is nonrepresentative. Recall, social desirability, and interviewer fatigue affect the accuracy of reported answers rather than who was included.

Question 22Assessment of Needs and Capacity

The Delphi technique is best characterized by which of the following?

  1. Direct observation of behavior in a setting
  2. Anonymous rounds of expert judgment Correct answer.
  3. Random-digit-dial telephone polling
  4. A single open community meeting

Explanation

Delphi gathers expert opinion through repeated questionnaires in which responses are summarized and shared anonymously until views converge. Anonymity and iteration reduce dominance by outspoken members and the pressure toward conformity found in face-to-face meetings.

Question 23Assessment of Needs and Capacity

A county of 250,000 residents records 1,200 new cases of a reportable disease in one year. What is the annual incidence rate per 100,000 population?

  1. 480 Correct answer.
  2. 4,800
  3. 120
  4. 48

Explanation

Incidence rate per 100,000 equals new cases divided by population, multiplied by 100,000. Dividing 1,200 by 250,000 gives 0.0048, which becomes 480 when multiplied by 100,000.

Question 24Planning

A planner writes the objective: 'By December 31, 40% of ninth graders will report refusing an offer of a vaping product.' Which element of a SMART objective does the phrase 'By December 31' supply?

  1. Time-bound Correct answer.
  2. Specific
  3. Relevant
  4. Achievable

Explanation

A time-bound element fixes the deadline by which the stated change must occur, and 'By December 31' supplies that deadline. Specificity describes exactly who will do what and how much, while achievable and relevant address feasibility and alignment with the program's mission.

Question 25Planning

Which statement is a program goal rather than a program objective?

  1. By year end, 25% of participants will add 60 minutes of weekly activity.
  2. By month three, 50 residents will attend each cooking class.
  3. Within 90 days, 80% of clinic staff will complete the counseling training.
  4. To reduce the burden of obesity among county residents. Correct answer.

Explanation

Goals are broad, long-range statements of the intended benefit, so they lack numbers and deadlines. Objectives are precise, measurable, and time-bound, which is why the other options specify a time frame, a target population, and a numeric criterion.

Question 26Planning

Which of the following is a source of secondary data for a community health needs assessment?

  1. Observations the planner recorded during a site visit
  2. Birth and death records maintained by the state health department Correct answer.
  3. Responses from a telephone survey the planner just fielded
  4. Notes from a focus group conducted last week

Explanation

Secondary data are already collected and archived by another party, such as vital statistics, census files, and surveillance reports. Primary data are newly gathered by the planner through surveys, focus groups, or direct observation.

Question 27Planning

The specific subgroup that a planned program is designed to serve is referred to as the

  1. planning committee
  2. priority population Correct answer.
  3. host agency
  4. advisory board

Explanation

The priority population is the group selected to receive the intervention because it bears the greatest need or offers the greatest opportunity for change. Advisory boards and planning committees govern or guide the work, and the host agency is the organization that houses the program.

Question 28Planning

Which is a primary benefit of involving stakeholders early in program planning?

  1. It builds shared ownership among those affected. Correct answer.
  2. It shortens the time required for ethical review.
  3. It removes the need for a formal needs assessment.
  4. It guarantees that funding will be renewed.

Explanation

Early stakeholder engagement builds trust, relevance, and a sense of ownership, which supports later implementation and participation. It supplements rather than replaces a needs assessment and has no bearing on funding or ethics review timelines.

Question 29Planning

In a logic model, the activities column describes

  1. the actions the program will carry out Correct answer.
  2. the immediate knowledge gained by participants
  3. the long-term health changes expected
  4. the resources invested in the program

Explanation

A logic model flows from inputs (resources) to activities (what the program does), then outputs and outcomes. Activities are the planned actions such as classes, screenings, or policy work.

Question 30Planning

Before mailing a survey to 1,000 residents, a planner administers it to 10 people to check wording, instructions, and item order. This practice is called

  1. pretesting Correct answer.
  2. process evaluation
  3. triangulation
  4. random sampling

Explanation

Pretesting (pilot testing) a data collection instrument with a small group identifies confusing items and procedural problems before full administration. Sampling concerns who is selected, process evaluation concerns delivery of a program, and triangulation concerns combining multiple data sources.

Question 31Planning

Which is an example of a process objective?

  1. Within six months, participants' average blood pressure will fall by 8 mmHg.
  2. By month four, staff will have delivered 16 nutrition sessions to 200 adults. Correct answer.
  3. By year two, obesity prevalence among participants will drop by 5%.
  4. By program end, 70% of participants will report eating more vegetables.

Explanation

Process objectives document the delivery of program activities, such as the number of sessions held and participants reached. Impact and outcome objectives describe changes in behavior, risk factors, or health status among participants.

Question 32Planning

In the PRECEDE-PROCEED model, predisposing, enabling, and reinforcing factors are identified during which phase?

  1. Educational and ecological assessment Correct answer.
  2. Social assessment
  3. Administrative and policy assessment
  4. Epidemiological assessment

Explanation

Phase 4, the educational and ecological assessment, sorts influences on behavior and environment into predisposing, enabling, and reinforcing factors. Social assessment addresses quality of life, epidemiological assessment addresses health status, and administrative and policy assessment addresses resources and barriers to implementation.

Question 33Planning

A planner adds guided practice and encouragement from peers who have successfully managed their condition so that participants come to believe they are capable of doing the same. Which construct of Social Cognitive Theory is being strengthened?

  1. Reinforcement
  2. Self-efficacy Correct answer.
  3. Outcome expectations
  4. Behavioral capability

Explanation

Self-efficacy is a person's confidence in their ability to perform a specific behavior, and it is built through mastery experiences, modeling, and verbal persuasion. Behavioral capability refers to knowledge and skill, reinforcement refers to consequences that sustain behavior, and outcome expectations refer to anticipated results of acting.

Question 34Planning

For participants who are in the contemplation stage of change, the most appropriate planning strategy is to

  1. teach relapse-prevention skills and provide ongoing support
  2. help participants weigh the pros and cons of changing Correct answer.
  3. raise awareness that the behavior is a health problem
  4. arrange environmental supports that make the behavior easy

Explanation

People in contemplation are thinking about change but ambivalent, so decisional balance work on pros and cons fits best. Awareness raising targets precontemplation, skill building and support fit action and maintenance, and environmental supports mainly assist those preparing for or already acting.

Question 35Planning

Before adopting an evidence-based intervention for a new population, the planner should first determine whether the intervention

  1. fits the needs, values, and setting of the priority population Correct answer.
  2. has been endorsed by a national professional association
  3. was evaluated using a randomized controlled design
  4. has been described in a peer-reviewed journal

Explanation

Evidence of effectiveness is necessary but not sufficient; the intervention must also be appropriate for the new population, setting, and resources. Endorsement, study design, and publication are indicators of evidence quality, not of fit.

Question 36Planning

Which principle is central to community-based participatory research?

  1. Findings are released only after journal publication.
  2. External researchers retain control of the data.
  3. Community members share in decisions at every stage. Correct answer.
  4. Recruitment is limited to clinic patients.

Explanation

Community-based participatory research is defined by shared power and co-learning, with community partners involved in defining problems, collecting and interpreting data, and using results. Researcher control, narrow recruitment, and delayed dissemination contradict that principle.

Question 37Planning

Translating a program's materials into the community's primary language and using photographs of neighborhood residents addresses which level of cultural adaptation?

  1. Fidelity monitoring
  2. Surface structure Correct answer.
  3. Formative evaluation
  4. Deep structure

Explanation

Surface structure involves matching observable characteristics such as language, images, food, music, and settings to the priority population. Deep structure involves incorporating the group's core values, norms, and beliefs about the health issue into the program's content.

Question 38Planning

Agency-wide insurance, general administration, and overall facility upkeep that cannot be assigned to a single program activity are best classified as

  1. indirect costs Correct answer.
  2. start-up costs
  3. in-kind contributions
  4. direct costs

Explanation

Indirect costs are shared organizational expenses that support the program as a whole but are not attributable to specific activities. Direct costs are tied to identifiable activities, in-kind contributions are donated goods or services, and start-up costs are one-time expenses of launching a program.

Question 39Planning

Which approach is most likely to improve recruitment of a hard-to-reach population?

  1. Partnering with trusted community groups Correct answer.
  2. Relying on a single mass-media announcement
  3. Holding all sessions at a large regional hospital
  4. Requiring participants to enroll online only

Explanation

Trusted community organizations and social networks reach people that formal channels miss and reduce mistrust of unfamiliar institutions. Single-channel announcements, online-only enrollment, and distant or unfamiliar sites create access barriers that depress participation.

Question 40Planning

A Gantt chart is used in program planning primarily to

  1. show tasks and their scheduled start and end dates Correct answer.
  2. rank health problems by their importance
  3. display the program's theory of change
  4. estimate the cost of each program activity

Explanation

A Gantt chart is a timeline tool that displays tasks as bars across a calendar, making start dates, durations, and overlaps visible. Ranking problems, depicting a theory of change, and costing activities are served by other planning tools.

Question 41Planning

Which action best supports long-term continuation of a program after grant funding ends?

  1. Keeping program activities confined to one staff member
  2. Postponing evaluation until the final funding year
  3. Relying on volunteer labor for all core services
  4. Embedding activities in agency policies and job duties Correct answer.

Explanation

Sustainability is strengthened when program activities become part of routine organizational structures, such as written policies, standard workflows, and staff job descriptions. Concentrating activities in one person, depending entirely on volunteers, or delaying evaluation makes continuation fragile.

Question 42Planning

A planner finds that a program's effect on physical activity operates through increases in social support. In this model, social support is a

  1. moderator
  2. confounder
  3. covariate
  4. mediator Correct answer.

Explanation

A mediator is an intervening variable that explains the pathway through which an intervention produces its effect. A moderator changes the strength or direction of an effect, a confounder is associated with both exposure and outcome and distorts their relationship, and a covariate is any variable statistically controlled in an analysis.

Question 43Planning

When adapting an evidence-based program, the greatest risk of removing or heavily modifying its core components is that

  1. the outcomes that made the program effective may be lost Correct answer.
  2. the program will be harder to market to partners
  3. the program will need more staff training hours
  4. the program's cost per participant will increase

Explanation

Core components are the elements believed responsible for the program's effects, so altering them threatens fidelity and the results observed in the original evaluation. Marketing difficulty, cost changes, and training burden are possible side effects but not the defining risk of weakening core components.

Question 44Planning

An intervention that proved effective in a randomized trial conducted at an urban academic clinic is being considered for a rural county. The main planning concern is the intervention's

  1. statistical power of the original analysis
  2. internal validity of the original trial
  3. reliability of the original outcome measures
  4. generalizability to the new setting and population Correct answer.

Explanation

Generalizability, or external validity, is the extent to which results obtained in one setting and population apply to another. Internal validity, statistical power, and measurement reliability concern the quality of the original study rather than its fit for the new context.

Question 45Planning

A planning team specifies magnitude, severity, and feasibility of change as weighted criteria and scores each candidate health problem against them to decide what to address first. This technique is best described as

  1. a formal cost-benefit analysis
  2. a criteria-based priority ranking Correct answer.
  3. a community asset inventory
  4. a force-field analysis

Explanation

A criteria-based priority ranking assigns weights to agreed-upon criteria and scores options against them to produce a transparent ordering. Cost-benefit analysis compares monetary costs with monetary benefits, asset inventories catalog community strengths, and force-field analysis examines pressures for and against a change.

Question 46Implementation

A health education specialist delivers a school-based curriculum exactly as its developers specified, keeping the prescribed lessons, sequence, and time allotments. This practice is best described as:

  1. Process evaluation
  2. Tailoring the intervention
  3. Conducting a pilot test
  4. Implementation fidelity Correct answer.

Explanation

Fidelity is the degree to which an intervention is delivered as designed, including the same core content, sequence, and dose. Delivering the prescribed lessons without omissions or additions is the defining feature of high fidelity.

Question 47Implementation

A trainer preparing a workshop for experienced adults should design the session primarily to:

  1. Build on learners' prior experience and real problems Correct answer.
  2. Delay application until after a final exam
  3. Emphasize memorization of definitions and terminology
  4. Present the entire content in one uninterrupted lecture

Explanation

Adult learning theory holds that adults are problem-centered and bring experience that should be used as a resource. Activities connecting content to real situations increase relevance and retention.

Question 48Implementation

A health education specialist wants to confirm that a client can follow a new insulin regimen. Which approach is most appropriate?

  1. Providing a written handout and ending the session
  2. Repeating the same instructions more slowly and loudly
  3. Asking the client whether everything is clear
  4. Having the client demonstrate and explain the steps Correct answer.

Explanation

Teach-back asks the learner to restate or demonstrate the information in their own words, revealing gaps that a simple 'Do you understand?' will miss. It is a recommended health literacy practice for confirming comprehension of clinical instructions.

Question 49Implementation

A campaign gives each participant a free step-tracking device and a printed activity guide as part of what the program offers. In the social marketing mix, these items are best classified as:

  1. Promotion
  2. Place
  3. Product Correct answer.
  4. Price

Explanation

In the social marketing mix, product includes the tangible goods, services, and benefits offered in exchange for adopting the behavior. A device or guide given to participants is part of that product offering.

Question 50Implementation

Which communication behavior is a core component of motivational interviewing?

  1. Persuading the client to accept a plan
  2. Advising the client before exploring concerns
  3. Reflecting back what the client has said Correct answer.
  4. Warning the client about consequences

Explanation

Motivational interviewing relies on open questions, affirmations, reflections, and summaries to evoke the client's own reasons for change. Reflection is the central skill for conveying empathy and encouraging change talk.