A Job Analysis of Patient and Health Care Advocates
Conducted by the Patient Advocate Certification Board
The Patient Advocate Certification Board (PACB) is the national certification body for patient and healthcare advocacy professionals. The mission of PACB is to serve the public interest by advancing patient and healthcare advocacy professional practice through evidence-based certification standards and the validation of knowledge essential for effective practice.
The Patient Advocate Certification Board (PACB) is a not-for-profit certifying body for individuals with education and experience in the practice of patient and healthcare advocacy. As with other certification programs, PACB’s credential aims to establish that individuals have the knowledge necessary to perform tasks critical for safe and competent practice as a patient or health care practitioner. PACB is committed to maintaining a fair, valid, and reliable assessment. PACB follows established processes for determining the content of the exam, including the completion of a job task analysis study.
The Patient Advocate Certification Board, an organization chartered to develop and maintain the Board Certified Patient Advocate Credential conducted a job task analysis (JTA) study to obtain descriptive information about the tasks performed in the job of patient and health care advocate and the knowledge needed to competently perform those tasks. This project was initiated in 2019 and serves as the first formal job analysis study of individuals working in the rapidly emerging profession of health and patient advocacy. The purpose of the Job Task Analysis is to provide the first detailed overview of the job-related competencies required to perform as a patient or healthcare advocate. The BCPA exam focuses on entry-level areas of professional practice that are critical to ensuring that patient and health care practitioners have the knowledge necessary to perform tasks critical for safe and competent practice as an entry-level patient and health care advocate. For certification purposes, a job task analysis study is used to establish a clearly delineated set of domains, tasks, and associated knowledge statements necessary to carry out the responsibilities of the job according to the standards required for certification.
The job task analysis serves as a blueprint for the content (performance domains) of the PACB Board Certified Patient Advocate examination. The JTA was created to define the current tasks, knowledge, skills, and abilities (KSA) that must be demonstrated by entry-level advocates to provide these services effectively and safely. KSAs are validated based on both importance and frequency of use in performance of the job. More simply, a profession can be broken down into performance domains that broadly define the profession being delineated. Each performance domain is then broken down into tasks that help define each performance domain. In turn, each task is further delineated into knowledge and skill statements which elaborate in greater detail on each task.
All professional organizations supporting specific professions or industries must continually seek to define roles and functions using evidence-based literature and knowledge from practice to identify the roles and functions of the profession. The information is then used to provide guidance to the construction or revision of the Body of Knowledge. The establishment of a valid job analysis is essential to the integrity of a credentialing program and its associated exam.
The job analysis translates practice into a usable format for test development and delineates the important tasks and knowledge deemed necessary for competent practice. In other words, a job analysis helps ensure that a certification exam is both job-related and has content validity. The Job Task Analysis is the tool that links the content of the certification exam to field-identified important job tasks and is an essential component in establishing the content validity of a credentialing exam. (Standards for Educational and Psychological Testing, 2014).
Some definitions are important for understanding the material presented in this report.
Task statements provide a standardized, concise description of the actions being performed by the professional, including to whom, with what material or intent, and with what expected outcome.
Domains consist of the larger groupings of responsibilities that characterize the practice or profession. Domains are generally denoted as major headings and include logical groupings of the task statements.
Knowledge statements refer to critical information an individual must possess to perform a task competently. Lack of this knowledge would result in the inability to perform the task, which may result in negative consequences for the recipient of the service.
Job Task Analysis (aka Practice Analysis Study, Role Delineation Study)
The Job Task Analysis is the primary method used to identify and prioritize the important tasks of a job or profession and the essential competencies an individual should possess to perform the required functions satisfactorily. For certification organizations, the practice analysis study is used to establish a clearly delineated set of domains, tasks, and associated knowledge statements necessary to carry out the responsibilities of the job to the standards required for certification. Most standards for the accreditation of certification programs (e.g., American National Standards Institute [ANSI] and Institute for Credentialing Excellence [ICE]) require verifiable association between the exam content outline and the data collected through the JTA.
Validity refers to whether or not the test measures what it claims to measure. An exam with high validity means the items (questions) will be closely linked to the intended focus of the test and are highly related to performance of the role.
The purpose of the PACB 2020 Job Analysis Study is to identify and validate tasks and knowledge important in the work performed by patient and health care advocates. The results of the study will be utilized to create test specifications which will guide the development of future versions of the BCPA exam. The study results will also serve as a framework for PACB regarding content selection of continuing education for re-certification.
A job analysis Advisory Committee was identified by PACB to provide oversight and content expertise throughout the job analysis process. The Advisory Committee represented diverse backgrounds in patient and health advocacy. The Advisory Committee was charged with the following tasks:
- Develop and organize a listing of job tasks
- Develop and organize a listing of related knowledge, skill, and abilities statements
- Develop a set of demographic questions for use in describing respondent groups and formation of subgroups for further analysis
- Along with expert assistance, utilize survey results to review and/or revise the examination blueprint.
Knowledge Skills Abilities
KSAs include the physical and mental capabilities that a practitioner must possess to perform a job competently, ethically, and safely.
Tasks are the individual functions, whether mental or physical, necessary to carry out an aspect of a specific job.
Job Task Analysis Advisory Committee
For the purposes of this study, the Advisory Committee adopted a very broad definition of the target practitioner inviting all respondents practicing in the field of patient and health care advocacy regardless of specialty or education. Furthermore, the survey was not limited to those who had earned the Board Certified Patient Advocate (BCPA) credential.
Survey distribution was implemented via anonymous link to the questionnaire and circulated to patient advocates through convenience sampling using snowball sampling techniques. The survey is sent to known patient advocates using distribution lists from patient advocate organizations and through patient advocates who have known connections to other patient advocates.
Identifying major classifications of tasks
The Advisory Committee initially compiled a comprehensive list of Tasks, Knowledge, Skill, and Ability statements. The major classifications somewhat align with the Domains outlined in the Competencies and Best Practices for Board Certified Patient Advocates and the Ethical Standards for a Board Certified Patient Advocate (Appendix 1). However, given the JTA study offers a unique opportunity to explore the diverse backgrounds and work setting associated with patient and health care advocates, the committee, after research and consultation with practicing advocates, agreed upon the following classifications.
- Delivering patient advocacy services
- Access, Finance, and Management of Healthcare Services
- Coordinating Services
- Adhering to Ethical, Legal, and Practice Standards
- Research Referral Treatment Options
- Hospital or Facility-Based Tasks
- Psychosocial Concepts and Support Systems
- Patient Advocacy Skills and Abilities
- Communication and Interpersonal Relationships
Identifying Task and Knowledge Statements
A variety of methods exist for conducting a job analysis. The most accepted practice is to use multiple sources of job information and then check for agreement among subject matter experts (SMEs) (in this case, professional patient and health care advocates). In preparation for the PACB Job Task Analysis, several sources of information about entry-level practice were considered, including the groundwork established by the founding board of PACB, an extensive literature review, a comprehensive inventory of patient advocate job descriptions, and a review of government databases (ONet and OPM). From these data sources, an inventory of job-related tasks and knowledge statements was compiled and reviewed by the Advisory Committee.
Two groups of Subject Matter Experts (SME) were recruited to review the DRAFT list of Task, Knowledge, Skill, and Ability statements (Table 1 and Table 2). Subject matter experts are qualified job incumbents who perform, train, and/or supervise individuals in the profession being studied. The Advisory Committee made a significant effort to ensure SMEs represented the diversity of the practice with respect to gender, age, race, years of experience, etc.). Both SME groups were experienced and active in their respective positions and represented the various work settings and areas of specialization in patient and health advocacy.
In addition to completing the DRAFT survey instrument, the initial group of SMEs met on two occasions to review each statement and provide feedback. A revised survey was presented to a second group of SMEs for feedback which was also incorporated into the survey instrument. A final review by the Advisory Committee resulted in the following:
|Task Domains||Number of Task Statements|
|Delivering Patient Advocacy Services||35|
|Access, Finance, and Management of Healthcare Services||25|
|Adhering to Ethical, Legal, and Practice Standards||10|
|Research Referral Treatment Options||6|
|Hospital or Facility-Based Tasks||34|
Table 1. Task domains for patient advocate job task analysis instrument
|Knowledge Domains||Number of Knowledge Statements|
|Healthcare Access, Finance, and Management||22|
|Psychosocial Concepts and Support Systems||20|
|Patient Advocacy Skills and Abilities||28|
|Ethical, Legal, and Practice Standards||9|
|Communication and Interpersonal Relationships||14|
Table 2. Knowledge domains for patient advocate job task analysis instruments
SME Group One
- Lisa Berry Blackstock
- TD Land
- Miguel Arenas
- Jennifer Whalen
- Ginger Onyeka
- Susan Hager
- Tzachi Litov
- Lesslee Dort
- Peter Habicht
- Susan McPhail Taylor
- Hector Franco
SME Group Two
- John Brewer III
- Jeffrey Byars
- Carol Campbell
- Grace Cordovano
- Steve Corn
- Jessica Fisher
- Sharondeep K. Grewall
- Danielle Goss
- Dana Phillips Hutson
- Gary Klein
- Kenneth Klein
- Marina Letourneau
- Bryan Link
- Ferial Maghami
- Darrell Underwood
In February 2021, the survey was launched by PACB with assistance from partner organizations including NAHAC, HealthAdvocateX, the Alliance of Professional Health Advocates, Greater National Advocates, and others. The survey concluded on August 31, 2021.
When the total population of a professional practice is small or unknown, the main challenge in conducting the job analysis or in developing meaningful competency profiles lies in identifying a sufficient number of qualified individuals to participate in the study. While validation by credential holders is the standard method for test specifications, validation by Subject Matter Experts (SMEs) is sometimes necessary. Newly established credentialing programs may also have a smaller potential population of credential holders to participate in the study. These considerations are important in determining how many respondents are necessary to interpret and validate the survey results.
For example, assume the total potential population of advocate credential holders is 2,000 individuals and that the desired margin of error +/- 5% at a confidence level of 95%, 323 survey respondents would be required. Since this is the first formal Job Analysis Study to be conducted in patient and health care advocacy, decisions to be made from survey results do not require precision at 5% (see table 3).
Table 3. Sample Size Requirements 
|Potential Population of Credential Holders||Potential Population of Credential Holders|
|Margin of Error||2,000||5,000|
 ICE Accreditation Standards 2016
 Certification – The ICE Handbook Third Edition
Using Cronbach’s Alpha, to check the reliability of the measure, the measure had α=98.9, suggesting a high degree of agreement among respondents. Chronbach’s alpha, α (or coefficient alpha), developed by Lee Cronbach in 1951, measures reliability, also known as internal consistency or reliability. Cronbach’s alpha tests to see if multiple-question Likert scale survey results are reliable (see Figure 1). Summary statistics from the PACB JTAdata can be seen in Table 4.
|α ≥ 0.9||Excellent|
|0.9 ≥ α ≥ 0.8||Good|
|0.8 ≥ α ≥ 0.7||Acceptable|
|0.7 ≥ α ≥ 0.6||Questionable|
|0.6 ≥ α ≥ 0.5||Poor|
|0.5 > α||Unacceptable|
Figure 1. Interpretation of reliability of Cronbach’s Alpha for Likert Scale Questions
Summary Statistics from the Job Task Analysis
|Number of usable scores (n)||138||138|
|Reliability (coefficient alpha)||0.99||0.99|
|Coefficient alpha 95% Confidence Interval||0.99 < – – – – > 0.99||0.99 < – – – – > 0.99|
|Index of Reliability||1.00||0.99|
|Standard Error of Measurement||16.22 (1.3%)||17.4 (1.4%)|
Table 4. Summary Statistics
Use of Survey Data
Survey data was collected and compiled with the assistance of psychometricians and statisticians. A full report of the job task analysis is being written, published, and made available to the patient advocate community. The information collected will be used to construct a competency-based framework (for a brief discussion about the competency-based framework, see FAQs) which provides the most up-to-date information about the knowledge and skills that informs the content of the certification exam for the Board Certified Patient Advocate certification. The most up-to-date information about the JTA and the status of the evaluation and use of data can be found at www.pacboard.org/JTA. Additionally, the results of the job task analysis will be published in academic journals, on the PACB website, and in other relevant locations to help publicize the important work patient advocates are doing on a regular basis and the evidence that supports that work. For additional information, see the FAQs on the PACB website.
The data were first checked for normality of distribution using the Shapiro-Wilk test for normality (p<0.05). As expected with survey data, the data were not normally distributed. Therefore, non-parametric hypothesis testing (Wilcoxon-Rank Sum test) was employed throughout the analysis.
- Domain 1 – Task Area 1: Delivering Patient and Advocacy Services
- Domain 2 – Task Area 2: Access, Finance, and Management of Healthcare Services
- Domain 3 – Task Area 3: Coordinating Services
- Domain 4 – Task Area 4: Adhering to Ethical, Legal, and Practice Standards
- Domain 5 – Task Area 5: Research Referral Treatment Options
- Domain 6 – Task Area 6: Hospital or Facility-Based Tasks
- Domain 7 – Knowledge Area 1: Healthcare Access, Finance, and Management
- Domain 8 – Knowledge Area 2: Psychosocial Concepts and Support Systems
- Domain 9 – Knowledge Area 3: Patient Advocacy Skills and Abilities
- Domain 10 – Knowledge Area 4: Ethical, Legal, and Practice
- Domain 11 – Knowledge Area 5: Communication and Interpersonal Relationships
Q1: Are there meaningful differences in the frequency of tasks performed by advocates who specialize in billing/insurance vs advocates who do not consider billing and insurance to be a significant part of their practice?
A1: Analysis shows no statistically significant differences in frequency values between advocates who specialize in billing/insurance and those who don’t, as evidenced by p-values at a 95% confidence level. (See Table 5)
Q2: Are there meaningful differences in the frequency of tasks performed by advocates who work in an agency or medical setting compared to those who do not?
A2: Analysis shows a statistical significance in the frequency values between those who work in an agency or medical setting compared to those who do not in response to Domain 8 (p=0.0293). Within Domain 8, those who work in an agency or medical setting had higher frequency values within this domain. All others show no statistically significant difference. (See Table 6).
Q3: Are there meaningful differences in frequency between advocates who work in the hospital or military sectors, compared to advocates who work independently?
A3: In domains 2, 5, 6, 8, 9, and 11, there are statistically significant differences in frequency between sectors. Averages are ranked with p-values in Table 7.
|2||0.0463||Yes||Average highest for independent, followed by hospital/facility then military|
|5||0.0037||Yes||Average highest for military, followed by independent, then hospital/facility|
|6||0.017||Yes||Average highest for hospital/facility, followed by military, then independent|
|9||0.0043||Yes||Average highest for hospital/facility, followed by independent, then military|
|11||0.0088||Yes||Average highest for hospital/facility, followed by independent, then military|
DIFFERENCES IN IMPORTANCE
Q1: Are there meaningful differences in the level of importance between advocates who specialize in billing/insurance and advocates who do not consider billing/insurance to be a significant part of their practice?
A1: Analysis shows no statistically significant differences in importance values between advocates who specialize in billing/insurance and those who do not consider it to be a significant part of their practice, as evidenced by p-values at a 95% confidence level. (See Table 8)
Q2: Are there meaningful differences in the level of importance between advocates who work in an agency or medical setting compared to those who do not?
A2: Analysis shows no statistically significant differences in importance values between advocates who work in an agency/medical setting compared to those who do not. (See Table 9)
Q3: Are there meaningful differences in the level of importance of advocates who work in the hospital/facilities or military sectors, compared to those who work independently?
A3: In domains 2, 5, and 9 there are statistically significant differences in importance values between sectors. Averages are ranked with p-values in Table 10