Transforming climate change and health practice: a follow-up survey of participants in a global online professional education programme.

Introduction: Climate change poses unprecedented threats to global health, yet formal educational programmes preparing professionals to address this intersection remain limited. The Yale Climate Change and Health Certificate Program, launched in 2018, represents a pioneering online professional education initiative designed to build cross-sectoral capacity in climate and health. This study evaluated long-term outcomes for members of the programme's first nine cohorts (2018-2023). Methods: We conducted a mixed-methods evaluation that followed a slightly modified Kirkpatrick's four-level training evaluation model. Participants responded to questions that assessed Learning and Self-Efficacy through knowledge and confidence measures, Behaviour through career and engagement indicators and Results through work involvement comparisons. Latent class analysis identified distinct behaviour change patterns, while qualitative analysis explored behaviour change pathways through rapid-qualitative assessment. Data were collected via a Qualtrics survey distributed by email. Results: There were 205 survey respondents. The data demonstrated a gap between learning (ie, knowledge acquisition) and self-efficacy in applied skills: >90% of participants agreed or strongly agreed they understood 4 of 6 areas of knowledge queried; only 70%-78% agreed or strongly agreed they had confidence in applying 3 of 4 skills queried. The programme outcomes were substantial: 91.1% modified their work approach, 76.5% pursued climate activities outside work, 58.7% made career changes and 46.5% pursued additional education. Results showed professional engagement with climate and health increased from 45.4% to 65.9% after programme completion. There were two distinct behaviour change pathways: 'Integrators' (50.2%) who embedded climate perspectives into existing roles and 'Pivoters' (41.0%) who made substantial career transitions. Conclusions: The programme achieved learning and self-efficacy, behavioural and impact outcomes across Kirkpatrick levels. The identification of two behaviour change pathways provides a novel framework for understanding professional development impact. The knowledge-application gap highlights the need for enhanced experiential learning components in online professional education. These findings offer evidence-based principles for designing effective climate and health programmes as the field expands.