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MCHES practice questions

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Question 1Assessment

Which of the following is an example of primary data in a community health assessment?

  1. Census Bureau population estimates for the county
  2. Hospital discharge summaries compiled by a state agency
  3. Interview responses collected from residents by the assessment team Correct answer.
  4. State vital statistics records on births and deaths

Explanation

Primary data are collected firsthand by the assessment team for the specific purpose at hand, such as interviews, surveys, or observations. Secondary data are already gathered by someone else for another purpose and reused in the assessment.

Question 2Assessment

A community survey finds 5,000 adults living with diabetes and 400 adults newly diagnosed during the past year. What does the figure of 400 represent?

  1. Prevalence of diabetes
  2. Attack rate
  3. Case fatality rate
  4. Incidence of diabetes Correct answer.

Explanation

Incidence counts new cases that arise in a defined population during a specified period and reflects the rate of new disease occurrence. Prevalence counts all existing cases, old and new, at a point or period in time.

Question 3Assessment

Which participant group size is generally recommended for a community focus group?

  1. Twenty-five to thirty participants
  2. Six to ten participants Correct answer.
  3. Four to five participants
  4. Two to three participants

Explanation

Focus groups work best with enough participants to generate diverse perspectives but few enough that each person can contribute; roughly six to ten is the commonly recommended range. Much smaller groups limit discussion, and much larger groups become difficult to moderate.

Question 4Assessment

A health department wants outside experts to reach consensus on community health priorities without meeting face to face. Which method fits best?

  1. Delphi technique Correct answer.
  2. Photovoice
  3. Community forum
  4. Nominal group process

Explanation

The Delphi technique uses several rounds of anonymous questionnaires with controlled feedback so that experts can converge on consensus without direct interaction. This avoids the dominance and travel constraints of face-to-face group methods.

Question 5Assessment

An assessment team drives through a neighborhood recording housing conditions, available food outlets, and visible hazards. This activity is best described as:

  1. A secondary data review
  2. A sentinel event analysis
  3. A key informant interview
  4. A windshield survey Correct answer.

Explanation

A windshield survey is a structured observational drive or walk-through in which assessors record visible features of the physical and social environment. It produces firsthand observational data rather than narrative or already-published information.

Question 6Assessment

Which individual is the strongest choice for a key informant interview about barriers to prenatal care in a community?

  1. A national consultant who has never visited the community
  2. The director of the local prenatal clinic who works with clients daily Correct answer.
  3. A randomly selected resident drawn from the voter registration list
  4. A state epidemiologist who analyzes birth certificate data

Explanation

Key informants are chosen because of their position, experience, and direct knowledge of the issue and the community. A clinic director who interacts daily with prenatal clients holds exactly the practical insight the assessment needs.

Question 7Assessment

An assessment team studying a hard-to-reach population of uninsured migrant workers asks each participant to refer additional people. This sampling approach is called:

  1. Stratified random sampling
  2. Snowball sampling Correct answer.
  3. Cluster sampling
  4. Systematic sampling

Explanation

Snowball sampling relies on participant referrals to identify additional members of a population that cannot be readily listed or reached. It is a nonprobability method used when no adequate sampling frame exists.

Question 8Assessment

A simple random sample of 200 residents is drawn from a population of 50,000. Which statement about sampling error is accurate?

  1. It is unrelated to how participants are selected
  2. It arises only from data entry mistakes
  3. It can be eliminated by adding more questions to the survey
  4. It generally decreases as sample size increases Correct answer.

Explanation

Sampling error is the difference between a sample estimate and the true population value that results from studying only part of the population. It can be estimated statistically and generally shrinks as the sample grows larger.

Question 9Assessment

An instrument produces the same score each time it is administered, but it does not measure the construct it is intended to measure. The instrument is:

  1. Neither reliable nor valid
  2. Both reliable and valid
  3. Reliable but not valid Correct answer.
  4. Valid but not reliable

Explanation

Reliability concerns consistency and reproducibility of measurement, while validity concerns whether the instrument measures what it claims to measure. An instrument can be consistent yet systematically off-target.

Question 10Assessment

A 20-item knowledge scale is administered twice to the same group two weeks apart, and the two sets of scores correlate at r = 0.85. This finding best supports which property?

  1. Content validity
  2. Criterion validity
  3. Test-retest reliability Correct answer.
  4. Internal consistency

Explanation

Administering the same instrument to the same people on two occasions and correlating the scores is the standard test-retest design for estimating stability over time. Internal consistency instead examines agreement among items within a single administration.

Question 11Assessment

A written survey intended for a general adult audience tests at a twelfth-grade reading level. What is the most appropriate revision?

  1. Add more items so the scale is more precise
  2. Translate the survey into another language
  3. Use shorter sentences and replace technical terms with common words Correct answer.
  4. Increase the font size of the printed form

Explanation

Readability is lowered by shortening sentences and replacing jargon with everyday vocabulary so that respondents of varied literacy levels can understand the items. Formatting changes improve legibility but do not reduce reading difficulty.

Question 12Assessment

What is the main purpose of pilot testing a survey instrument before full administration?

  1. To reduce the number of respondents needed
  2. To satisfy funder reporting requirements
  3. To establish the statistical significance of the results
  4. To identify unclear items and administration problems in advance Correct answer.

Explanation

A pilot test is a small-scale trial run that reveals confusing wording, problematic response options, and logistical difficulties that can be corrected before the main data collection. Its focus is instrument and procedure quality, not statistical inference.

Question 13Assessment

A screening test has 95% sensitivity and 60% specificity. Which outcome is expected when this test is used?

  1. Most people without the condition will test negative
  2. Most people who test positive will truly have the condition
  3. Most people who truly have the condition will test positive Correct answer.
  4. Very few people without the condition will be misclassified

Explanation

Sensitivity is the proportion of truly affected people whom the test correctly identifies as positive, so a value of 95% means most true cases are detected. Specificity governs correct classification of unaffected people and is low here.

Question 14Assessment

The community readiness model is used primarily to:

  1. Determine a community's stage of readiness to act Correct answer.
  2. Measure changes in disease incidence over time
  3. Rank health problems by attributable mortality
  4. Estimate the cost per case averted by a program

Explanation

The community readiness model assesses how prepared a community is to address a particular issue and places it along a staged continuum. Strategies are then matched to the current stage so that interventions fit the community's capacity.

Question 15Assessment

Which assessment approach inventories the strengths and resources already present in a community?

  1. Needs assessment gap analysis
  2. Risk factor survey
  3. Asset mapping Correct answer.
  4. Epidemiologic surveillance

Explanation

Asset mapping catalogs the skills, organizations, facilities, and relationships a community already possesses. It complements needs-based approaches by identifying existing capacity that can be mobilized.

Question 16Assessment

A coalition must rank five candidate priorities and wants equal influence from every member without domination by a few vocal participants. Which technique best fits?

  1. Focus group discussion
  2. Nominal group process Correct answer.
  3. Delphi rounds with outside experts
  4. Open community hearing

Explanation

The nominal group process combines silent idea generation, round-robin recording, discussion, and individual ranking so that every member's judgment contributes equally. It is specifically designed to limit the influence of dominant personalities.

Question 17Assessment

A county uses state hospital discharge records to estimate the local burden of asthma. What is the most important limitation of this approach?

  1. The data are updated more frequently than survey data
  2. The data capture only people who sought hospital care Correct answer.
  3. The data include residents regardless of insurance status
  4. The data are gathered with a validated survey instrument

Explanation

Discharge data reflect only those who received hospital-based care, so people managed in primary care, uninsured people who forgo care, and mild cases are missed. This systematically understates community burden and skews the picture toward severe cases.

Question 18Assessment

What is the primary function of a public health surveillance system?

  1. Enroll residents in insurance programs
  2. Track health conditions continuously over time Correct answer.
  3. Evaluate the cost of treatment for chronic diseases
  4. Diagnose individual patients in clinical settings

Explanation

Surveillance is the ongoing, systematic collection, analysis, and interpretation of health data used to monitor problems and guide public health action. It operates at the population level rather than the individual clinical level.

Question 19Assessment

A county's crude death rate exceeds the state's, but after age adjustment the county rate falls below the state's. What is the best explanation?

  1. The county has an older population than the state Correct answer.
  2. The county has unusually complete death reporting
  3. The county has a smaller population than the state
  4. The county experienced an outbreak of a fatal disease

Explanation

Crude rates are influenced by the age composition of a population, so a population with more older residents will show a higher crude death rate even without greater risk. Age adjustment removes that compositional effect and reveals the underlying comparison.

Question 20Assessment

A mailed health survey achieves a 22% response rate, and respondents are more likely than nonrespondents to be older and insured. This problem is best described as:

  1. A social desirability effect
  2. Nonresponse bias Correct answer.
  3. Sampling frame error
  4. Random measurement error

Explanation

Nonresponse bias occurs when the people who choose to respond differ systematically from those who do not on characteristics relevant to the survey topics. Because older and insured residents are overrepresented, the results will not represent the full population.

Question 21Assessment

A team verifies survey findings by comparing them with focus group themes and clinic records. This practice is called:

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

Explanation

Triangulation involves confirming findings by drawing on multiple data sources, methods, or investigators to strengthen confidence in conclusions. Convergence across independent sources increases credibility.

Question 22Assessment

Which element is essential when collecting assessment data directly from community residents?

  1. Informed consent covering purpose, risks, and voluntary participation Correct answer.
  2. A written promise that the data will be used to fund new programs
  3. A requirement that participants complete every item on the instrument
  4. An agreement to share individual responses with local employers

Explanation

Respect for persons requires that participants receive understandable information about the purpose, procedures, risks, and benefits and that participation be voluntary. Consent also makes clear that respondents may decline or withdraw without penalty.

Question 23Assessment

A survey is translated into Spanish and then independently back-translated into English. This procedure primarily aims to:

  1. Reduce social desirability bias
  2. Increase the effective sample size
  3. Shorten the time needed to administer the survey
  4. Preserve meaning equivalence across languages Correct answer.

Explanation

Back-translation reveals places where the translated version drifts from the original meaning, allowing corrections before use. The goal is a version that measures the same constructs rather than a literal word-for-word rendering.

Question 24Assessment

A coalition ranks three health problems using magnitude, severity, feasibility of intervention, and community concern. This process is best described as:

  1. Criteria-based priority setting Correct answer.
  2. An epidemiologic transition
  3. A cost-benefit analysis
  4. A root cause analysis

Explanation

Priority setting applies explicit, weighted criteria so that decisions among competing problems are transparent and defensible. Combining burden measures with feasibility and community values is a standard criteria-based approach.

Question 25Planning

Which term refers to the systematic process of collecting and analyzing data to identify the health needs and assets of a priority population?

  1. Implementation planning
  2. Needs assessment Correct answer.
  3. Program evaluation
  4. Process evaluation

Explanation

A needs assessment is the systematic collection and analysis of data on a population's health status, needs, and assets to guide program planning. It occurs before priority setting and intervention design, so that later decisions rest on evidence.

Question 26Planning

Which term describes the skills, resources, relationships, and commitment a community or organization can mobilize to plan and sustain a program?

  1. Fidelity
  2. Reach
  3. Capacity Correct answer.
  4. Dose

Explanation

Community capacity is the combination of skills, resources, partnerships, and commitment available to plan, implement, and sustain an initiative. Assessing capacity is part of judging whether a community is ready to carry out a program.

Question 27Planning

Which statement best distinguishes a program goal from a program objective?

  1. A goal describes activities; an objective describes resources.
  2. A goal is measurable and time-specific; an objective is broad and general.
  3. A goal is written only for funders; an objective is written only for staff.
  4. A goal is broad and long-term; an objective is measurable and time-specific. Correct answer.

Explanation

Goals are broad, general statements of desired long-term direction, while objectives are specific, measurable, time-bound statements that operationalize the goal. This distinction lets planners connect a general aspiration to concrete, trackable commitments.

Question 28Planning

A planning team wants to involve the group that will be directly affected by a new program so that its design reflects real needs and preferences. Whose participation is most essential?

  1. Only licensed clinicians
  2. The priority population Correct answer.
  3. Only academic researchers
  4. Only the funding agency

Explanation

Engaging members of the priority population gives planners insight into needs, values, barriers, and acceptable delivery formats, increasing relevance and uptake. Other stakeholders contribute expertise, but the affected group's perspective is essential to sound planning.

Question 29Planning

In a logic model, which term describes the resources a program invests, such as staff, funding, and facilities?

  1. Outcomes
  2. Outputs
  3. Inputs Correct answer.
  4. Impact

Explanation

Inputs are the human, financial, material, and organizational resources invested in a program, and they enable the activities to occur. Later columns of the logic model then capture what those activities produce and change.

Question 30Planning

Which planning model begins with a social assessment of quality of life and then works backward to identify determinants before designing and evaluating interventions?

  1. RE-AIM
  2. Logic model
  3. Diffusion of Innovations
  4. PRECEDE-PROCEED Correct answer.

Explanation

PRECEDE-PROCEED starts with social assessment and moves backward through epidemiological, behavioral, and educational diagnoses to select interventions, then proceeds forward through implementation and evaluation. Its diagnostic phase is what makes it a comprehensive planning model rather than an evaluation or diffusion framework.

Question 31Planning

A planning team has limited resources and must choose a priority population from a large county. Which approach is most consistent with sound planning practice?

  1. Select the group with the loudest advocacy voice.
  2. Select a high-need subgroup that is reachable and justify the choice with data. Correct answer.
  3. Select the entire county population so that no group is excluded from the program.
  4. Select the group that is easiest to reach, regardless of need.

Explanation

Sound planning selects a priority population on the basis of documented need combined with the feasibility of reaching and serving that group, and the rationale is made explicit. This focuses scarce resources where they can produce the greatest benefit and reduces the risk of widening disparities.

Question 32Planning

Which statement is written as a measurable process objective for a new nutrition education course?

  1. Participants will value healthy eating.
  2. Type 2 diabetes incidence will decline among county adults over the next ten years.
  3. The program will improve community health and well-being.
  4. By week 8, at least 80% of participants will attend 6 or more sessions. Correct answer.

Explanation

A process objective describes an activity or participation milestone, such as attendance, and includes a measure, a target, and a timeframe. Attitudes and health status belong to outcome objectives, and they must be stated in measurable terms to be useful.

Question 33Planning

In a logic model, increased knowledge among participants is best classified as which type of element?

  1. An input
  2. A short-term outcome Correct answer.
  3. A long-term health outcome
  4. An activity

Explanation

Short-term outcomes are changes in learning, including knowledge, attitudes, and skills, that typically occur soon after participation and precede behavior change. They sit earlier in the results chain than behavior and health-status outcomes.

Question 34Planning

A planning team needs a framework that explains how a new behavior spreads through social networks and is adopted over time by members of a community. Which framework is most relevant?

  1. Precede-Proceed planning framework
  2. Diffusion of Innovations Correct answer.
  3. Health Belief Model
  4. Transtheoretical Model

Explanation

Diffusion of Innovations describes how new behaviors and programs spread through social systems over time via communication channels, opinion leaders, and different adopter categories. It is the appropriate choice when the planning question concerns spread and adoption across a community.

Question 35Planning

When adapting an evidence-based program for a new cultural group, which action is most appropriate?

  1. Deliver the program exactly as originally designed without any changes.
  2. Replace the program with a new untested design.
  3. Cut the program to half its length to save money.
  4. Keep core components while adapting surface elements to context. Correct answer.

Explanation

Adaptation should preserve the core components linked to the program's effectiveness while adjusting surface elements such as language, examples, imagery, and delivery setting to fit the new population. This balances fidelity with cultural relevance.

Question 36Planning

A planner is forming a community coalition to address youth obesity. Which action is the most appropriate first step?

  1. Draft the final grant report before any meetings occur
  2. Purchase all program materials for the first year
  3. Set the coalition's purpose and recruit key members Correct answer.
  4. Appoint a media spokesperson and schedule a press event

Explanation

A coalition must first clarify its purpose, intended outcomes, and membership so that recruitment targets the sectors needed to succeed. Operational tasks such as messaging and purchasing follow once structure and direction are established.

Question 37Planning

A planner is developing a program budget and wants it to be realistic. Which action is most appropriate?

  1. Exclude personnel costs so the budget appears smaller
  2. Set the budget to equal last year's unrelated program budget exactly
  3. Wait until after implementation to estimate all costs
  4. Estimate activity costs and compare them with committed resources Correct answer.

Explanation

A realistic budget ties costs to planned activities and compares them against confirmed funding and in-kind contributions, so gaps can be addressed before implementation. This activity-based approach keeps the plan feasible and defensible to funders.

Question 38Planning

During program planning, a Gantt chart is most useful for which purpose?

  1. Measuring long-term health outcomes
  2. Calculating statistical power
  3. Comparing the program to national benchmarks
  4. Scheduling activities and tracking progress Correct answer.

Explanation

A Gantt chart displays tasks across a timeline, showing start and end dates and progress, which helps coordinate staff and monitor whether milestones are being met. It is a management tool for sequencing work rather than a measurement technique.

Question 39Planning

Before full-scale implementation, a planner conducts a pilot test of the intervention. What is the primary purpose?

  1. To prove the program causes behavior change in the population
  2. To satisfy funders' reporting requirements
  3. To find and fix practical problems in delivery and materials Correct answer.
  4. To replace the need for program evaluation

Explanation

Pilot testing surfaces logistical, cultural, and material problems on a small scale so they can be corrected before large investments are made. It improves feasibility and acceptability rather than establishing population-level effectiveness.

Question 40Planning

A planning team wants a community program to continue after grant funding ends. Which strategy is most appropriate?

  1. Reduce all evaluation activities to save money.
  2. Rely on the original grant funds indefinitely.
  3. Delay sustainability planning until the final month of the grant period.
  4. Build partnerships and diversify funding sources during planning. Correct answer.

Explanation

Sustainability is strengthened when local partnerships, organizational ownership, and diversified funding are developed throughout planning rather than at the end of a grant. Early attention allows time to secure commitments and embed the program in local systems.

Question 41Planning

A planner determines that low self-efficacy is a key determinant of physical inactivity among participants. Which strategy is most directly aligned with that determinant?

  1. Guided practice with mastery experiences and peer modeling Correct answer.
  2. Financial incentives for attending a single information session
  3. Distribution of written physical activity guidelines only
  4. Policy changes to school vending machines

Explanation

Self-efficacy is built primarily through mastery experiences, vicarious learning from similar others, verbal persuasion, and reduced physiological arousal. Guided practice with modeling directly targets confidence and skill, matching the identified determinant.

Question 42Planning

Which planning practice best ensures that a program's evaluation will be feasible and useful?

  1. Limiting evaluation to participant satisfaction surveys
  2. Assigning evaluation solely to an external evaluator with no program knowledge
  3. Specifying evaluation questions and indicators when writing program objectives Correct answer.
  4. Selecting evaluation measures only after implementation is complete

Explanation

Writing evaluation questions and indicators alongside objectives ensures the evaluation measures what the program intends to achieve and that baseline and follow-up data collection are built in from the start. Planning evaluation concurrently with the intervention prevents later mismatches between objectives and measures.

Question 43Planning

A planning team states an objective, identifies behavioral and environmental factors, identifies their determinants, and then selects theory-based methods and practical applications. Which approach does this sequence describe?

  1. Diffusion of Innovations
  2. Intervention Mapping Correct answer.
  3. Health Belief Model
  4. RE-AIM framework

Explanation

Intervention Mapping is a stepwise planning protocol that produces planning matrices linking behavioral and environmental factors and their determinants to theory-based methods and practical applications. Its defining feature is the explicit matrix connecting determinants to methods and then to delivered program components.

Question 44Planning

A planning committee must choose among several possible interventions with limited resources. Which set of criteria is most defensible for prioritizing the options?

  1. Number of materials already printed and available
  2. Need, evidence of effectiveness, feasibility, and community fit Correct answer.
  3. Popularity among staff and ease of scheduling
  4. Length of time the intervention has existed and the size of its budget

Explanation

Priority setting should be explicit and defensible, weighing the magnitude of need, the strength of evidence for the option, feasibility within available resources, and fit with community values. Criteria of this kind connect the choice to expected benefit rather than to convenience or sunk costs.

Question 45Implementation

Before launching a new health education program agency-wide, staff first deliver it to a small group of participants. The main purpose of this pilot test is to:

  1. document long-term cost savings
  2. prove the program's theory is valid
  3. meet funders' routine reporting requirements
  4. identify problems before broad rollout Correct answer.

Explanation

Pilot testing is an implementation step used to detect feasibility, comprehension, and logistical problems while changes are still inexpensive. It is not designed to prove theory or demonstrate long-term savings. Findings from the pilot are used to refine procedures before scaling up.

Question 46Implementation

In program implementation, fidelity refers to the extent to which a program is:

  1. rated favorably by its staff
  2. delivered as originally designed Correct answer.
  3. funded at the requested level
  4. enrolled to its full planned capacity

Explanation

Fidelity concerns whether the program's core components, dose, and delivery methods match the intended design. Enrollment, staff satisfaction, and funding are related implementation factors but not definitions of fidelity. Monitoring fidelity helps explain why outcomes may differ across sites.

Question 47Implementation

Before volunteers deliver a new community curriculum, the minimum training they need should cover:

  1. social media advertising techniques
  2. organizational bylaws and governance
  3. program content and delivery procedures Correct answer.
  4. grant-writing and budget development

Explanation

Implementers need sufficient training in the curriculum content and in how each activity is to be delivered so they can carry out the program as intended. Governance, fundraising, and marketing may be useful elsewhere but are not core preparation for curriculum delivery. Training should match the tasks the implementers will perform.

Question 48Implementation

Which approach is most likely to improve recruitment of participants from an underserved neighborhood?

  1. Wait for residents to call after one radio announcement
  2. Restrict outreach to existing program alumni
  3. Partner with trusted neighborhood organizations Correct answer.
  4. Rely only on flyers posted inside a distant clinic

Explanation

Recruitment is strengthened when trusted local organizations help spread information and reduce mistrust. Single-channel or distant outreach often misses residents with limited access. Partnerships also help tailor messages and logistics to the community.

Question 49Implementation

A readability and suitability review of draft program materials is conducted primarily to:

  1. set outcome targets
  2. estimate program costs
  3. select staff to train
  4. confirm audience fit Correct answer.

Explanation

Readability and suitability reviews assess whether wording, layout, and examples match the intended audience's literacy and cultural context. Cost estimation, staff selection, and outcome targeting are separate implementation tasks. Materials that do not fit the audience can undermine participation and comprehension.

Question 50Implementation

A Gantt chart is most useful during implementation for:

  1. selecting a random sample of participants
  2. calculating the statistical power needed
  3. measuring the size of program effects
  4. showing task sequence and deadlines Correct answer.

Explanation

A Gantt chart displays tasks over time, making sequence, dependencies, and deadlines visible to the implementation team. It does not calculate statistical power, estimate effect sizes, or select samples. It is a scheduling and coordination tool.