CHES Practice Questions (2026) — Free Sample Questions with Answers

Answer: C

Primary quantitative data: The specialist did not collect the counts; they were recorded by the clinic for another purpose, so they are not primary data.

Primary qualitative data: The data are neither collected by the specialist nor narrative; they are numeric counts from existing records.

Secondary quantitative data: Correct. HESPA III 1.2: data collected by someone else for another purpose are secondary, and numeric visit counts are quantitative.

Secondary qualitative data: The records are secondary, but counts are numeric, not words, images or narratives.

Who collected the data and why decides primary vs secondary; numbers vs narrative decides quantitative vs qualitative.

Answer: B

Step 1: logic model of the problem: Step 1 describes the health problem, its behavioral and environmental causes and their determinants.

Step 2: program outcomes and objectives: Correct. Intervention Mapping step 2 states performance objectives and crosses them with determinants in matrices of change objectives.

Step 3: program design: Step 3 selects theory-based methods and practical applications to address the change objectives.

Step 4: program production: Step 4 produces and pretests the program materials and components.

Matrices of change objectives come from Intervention Mapping step 2; methods are chosen in step 3.

Answer: C

By June 2027, deliver 12 stress management workshops to employees: This counts program activities delivered, which makes it a process objective.

Participants will better understand how to manage their stress: This lacks a measurable criterion and a time frame, so it is not SMART.

By June 2027, 70% of participants will demonstrate two relaxation skills: Correct. HESPA III 2.2: impact objectives target short-term or intermediate change in knowledge, skills or behavior, and this one is specific, measurable and time-bound.

By 2030, reduce stress-related illness among employees by 15%: Change in health status over the long term is an outcome objective, not an impact objective.

Process = what the program delivers; impact = knowledge, skills, behavior, environment; outcome = long-term health status.

Answer: D

Residents are hired and paid as survey interviewers: Paid roles are valuable participation, but collecting data on the department’s design is not shared decision-making.

Residents review a finished plan and give feedback: Feedback on a completed plan is consultation; the decisions were already made without them.

Residents receive a plain-language summary at the end: Sharing results is good practice, but residents had no role in shaping the work.

Residents share decisions in every phase of the work: Correct. HESPA III 2.1: CBPR is an equitable partnership in which community members share power in every phase, from setting questions to acting on results.

CBPR means shared power across all phases; hiring, consulting or informing community members alone falls short.

Answer: C

Pretesting: Pretesting checks draft materials or messages with a few members of the audience before production.

Pilot testing: A pilot is a one-time small trial to find and fix problems before wider rollout; this plan already schedules the full rollout.

Phasing in: Correct. Phasing in introduces the program in planned stages (by site or group) until the whole population is reached.

Total implementation: Total implementation launches the program everywhere at once.

Pilot = small trial run; phasing in = staged expansion to everyone; total implementation = all at once.

Answer: C

Formative evaluation, because the work with owners is still going on: Formative evaluation tests materials and plans during development; policy adoption is a result, not a pretest.

Process evaluation, because it counts buildings the effort reached: Process measures count activities and reach, such as owners contacted; a building adopting a policy is a change the effort produced.

Impact evaluation, because it measures a change in the environment: Correct. HESPA III 4.1: impact covers short-term and intermediate changes, including policy and environmental change; long-term health status would be outcome.

Outcome evaluation, because it is measured two years after the start: Outcome refers to long-term health status (for example, asthma rates), not to how long after the start the measure is taken.

Policy and environmental changes are impact results; outcome is reserved for long-term health status and quality of life.

Answer: C

Maturation: Maturation is change from participants growing or developing over time, not from an outside event.

Instrumentation: Instrumentation is a change in how the outcome is measured; the same survey was used both times.

History: Correct. HESPA III 4.1: an outside event during the program (the district vending change) could explain the drop, which is the history threat a comparison group would help control.

Selection: Selection concerns differences between groups at the start; a one-group design has no second group to differ.

History = an outside event between pretest and posttest that could produce the change; comparison groups help rule it out.

Answer: C

A single cross-sectional study in a peer-reviewed journal: It is peer reviewed and credible, but one cross-sectional study cannot show program effects and is weaker than a synthesis.

A conference abstract reporting early program results: Abstracts give limited methods and are not fully peer reviewed, so they are preliminary evidence.

A peer-reviewed systematic review of program evaluations: Correct. HESPA III 5.5: supporting research includes identifying credible, evidence-informed sources; a systematic review synthesizes many studies with explicit methods.

A fact sheet from a vaping product trade group: A trade group has a commercial interest, which undermines the credibility of its claims.

Rank evidence by rigor and independence: systematic reviews above single studies, peer review above abstracts, independent above interested sources.

Answer: A

A playground press event calling on the council to fund shade: Correct. HESPA III 6.3: media advocacy uses news media strategically to push decision makers toward a specific policy change.

Ads reminding parents to bring water bottles to the playground: This promotes an individual behavior; it does not press decision makers for a policy.

Heat safety tips posted on the health department's social media pages: This is health communication to individuals, with no policy target.

Brochures on heat illness symptoms placed in public libraries citywide: Brochures inform individuals about symptoms and ask no decision maker to act.

Media advocacy uses media to advance a policy with a named decision maker; health communication uses media to change individual behavior.

Answer: A

A city policy funding sidewalks and crosswalks on school routes: Correct. HESPA III 6.1: the audit points to the built environment, so a policy that adds sidewalks and crosswalks changes conditions for every child who walks those routes.

A school board policy requiring yearly pedestrian safety lessons: This is a policy, but it changes what children are taught, not the unsafe routes the audit found.

A city ordinance raising fines for pedestrians who cross midblock: This policy penalizes individual pedestrians; with no crosswalks, it punishes behavior the environment forces rather than fixing the cause.

Reflective gear and safety assemblies at both elementary schools: Visibility gear and assemblies address individual behavior and leave the missing sidewalks and crosswalks unchanged.

When data point to an environmental cause of a disparity, advocate for the policy that changes that environment; a policy that only educates or penalizes individuals does not.

Answer: B

Make the images more severe to strengthen the impact: Raising threat while efficacy stays low makes defensive avoidance more likely, not action.

Add simple protective steps, such as shade and sunscreen: Correct. HESPA III 7.3: in the Extended Parallel Process Model, high threat with low efficacy leads to fear control; adding doable steps raises efficacy so people act.

Remove all risk content and rely on humor instead: Removing threat entirely leaves no reason to act; the gap is efficacy, not too much threat.

Add statistics on melanoma rates among young adults: More statistics add to perceived susceptibility (threat) without telling viewers what they can do.

Fear appeals work only when paired with strong efficacy messages: what to do and that the audience can do it.

Answer: C

Simple Measure of Gobbledygook (SMOG): SMOG estimates reading grade level from polysyllabic words only; it does not rate graphics, layout or culture.

Fry readability graph: The Fry graph estimates grade level from syllables and sentences; it does not rate design or cultural fit.

Suitability Assessment of Materials: Correct. HESPA III 7.4: SAM rates content, literacy demand, graphics, layout and typography, learning stimulation and cultural appropriateness.

Flesch-Kincaid grade level: Flesch-Kincaid gives a reading grade level only, not a broader suitability rating.

Readability formulas (SMOG, Fry, Flesch-Kincaid) estimate grade level; SAM judges overall suitability of a material.

Answer: A

Keep participation voluntary and share only aggregate results: Correct. 2020 Code of Ethics: specialists respect autonomy and protect the confidentiality of individuals’ health information.

Require attendance but keep individual results private: Protecting results is right, but requiring participation still violates voluntary consent.

Send results only for employees who agree verbally: Workplace pressure undermines verbal consent, and HR has no need for individual results.

Offer gift cards to employees who share their results with HR: Incentives to disclose personal results can be coercive and still expose individuals’ data.

Keep participation voluntary and individual health data confidential; report only aggregate results to employers.

Answer: A

Report all findings accurately, including the lack of behavior change: Correct. 2020 Code of Ethics: health education specialists report results truthfully and completely, even when they are unfavorable.

Place the behavior results in an appendix the summary does not mention: Technically including results while hiding them from readers is still misleading reporting.

Delay the report until next year’s data might look better: Withholding findings to wait for better ones misleads the funder about current results.

Describe the behavior data as encouraging early trends: Calling no change a positive trend misrepresents the evidence.

Report evaluation findings honestly and completely; unfavorable results are evidence for improving the program.