Development of a simple and effective online training for health workers: results from a pilot in Nigeria

The impact of osteoporosis virtual training course for general practitioners

This study evaluated the impact of a virtual training program on osteoporosis management for general practitioners. Among 498 participants, knowledge scores significantly increased from 38 to 83 (P < 0.001). The findings highlight the effectiveness of targeted education in enhancing practitioners' understanding, ultimately improving patient care and reducing healthcare costs.

PURPOSE

Osteoporosis is a widespread global health concern. Training the general practitioners with updated treatment strategies can notably lessen patient discomfort (fracture and mobility limitation) and costs. So, this study aimed to assess the impact of a training course on osteoporosis management knowledge targeted at general practitioners.

METHODS

A quasi-experimental study was conducted to train general practitioners about Osteoporosis. The study utilized a virtual education program accessible online and contained five key aspects of osteoporosis management. The impact of this program was evaluated by comparing pre-test and post-test scores across all 5 modules. Evaluation of Electronic Modules questionnaire was used to assess the quality of the osteoporosis virtual course. A linear regression analysis explored factors influencing physicians' knowledge percent change in 5 modules.

RESULTS

A total of 498 general practitioners participated in a virtual course on osteoporosis management. The average participant age was 35, and over 70% were women. The mean score for all five modules increased significantly, from 38 to 83, more than double the original score (P < 0.001). The analysis revealed that in Module 3 (Clinical Management), younger participants attained significantly higher post-test scores (β, - 0.28; 95% CI, - 0.55, - 0.01; P, 0.039). Also, most participants agreed or strongly agreed that the system is high-quality, offers valuable information, and services, and is both user-friendly and beneficial.

CONCLUSION

The virtual training course on osteoporosis management principles notably improved the participants' knowledge.

Online palliative care curriculum: contextual adaptation for Nigerian healthcare workers

OBJECTIVES

This study reports on a yearlong sequence of three periodic, virtual trainings in primary palliative care for healthcare professionals across Nigeria. Our overall objective was to determine the impact of the full course on participants' attitudes, knowledge, skills and plans to implement and deliver palliative care in their local contexts.

METHODS

The curriculum for this programme was codeveloped by a team of USA and Nigerian palliative care professionals and delivered via three 3-day virtual sessions. Daily surveys, knowledge tests and end-of-training surveys were administered to participants electronically. Demographics, knowledge scores, confidence levels and self-reported achievement were analysed using descriptive statistics.

RESULTS

Pretraining and post-training knowledge scores showed significant improvement with average gains of 10.3 percentage points in training 1 (p<0.001) to 11.7 percentage points in training 2 (p=0.01). More than three-quarters of participants improved their test scores. Most participants (89.4%-100%) agreed that they had achieved the daily learning objectives across all trainings. Nearly 100% of participants reported that they felt more empowered as healthcare workers, more confident in their decision-making and more comfortable communicating with patients and other healthcare workers about palliative care.

CONCLUSIONS

Healthcare workers in Nigeria demonstrated increased knowledge and confidence in providing palliative care as a result of an adapted virtual training programme. Further research is needed to (1) demonstrate feasibility for online trainings in similar resource-limited settings and (2) evaluate impact on patient-centred outcomes.

Delivering insecticide-treated nets (ITNs) through a digitized single-phase door-to-door strategy: lessons from Ondo state, Nigeria

BACKGROUND

The use of insecticide-treated nets (ITNs) is a strategy recommended by the World Health Organization (WHO) for malaria prevention. In Nigeria, ITNs have been periodically distributed since 2007 through campaigns. Campaign activities and assets are typically tracked using either a paper-based or digital system. In 2017, a digital approach was introduced in Ondo state for tracking attendance at training sessions as part of the ITN campaign. Following the success of the 2017 introduction, subsequent campaigns planned to digitise other aspects of the campaign to improve accountability and efficiency of the ITN distribution. The COVID-19 pandemic posed additional challenges for the ITN distribution planned for 2021 and adaptations were made to the programme strategy to ensure the campaign could go ahead safely. This article presents lessons and experiences from the 2021 ITN distribution campaign in Ondo state, Nigeria.

METHODS

The campaign used RedRose, a customised mobile application, to monitor the planning and delivery of the campaign, collect household information including training personnel and tracking the transfer of ITNs between distribution hubs and households. ITNs were delivered through a single-phase door-to-door distribution strategy.

RESULTS

The campaign distributed 2,965,125 ITNs covering 1,057,577 households across Ondo state. The digital application was beneficial for monitoring the quality of implementation and tracking assets and staff to ensure safety.. The single-phase door-to-door approach was more convenient for households compared to fixed-point distribution but increased the workload for mobilization and distribution teams.

CONCLUSIONS

Single phase door-to-door strategy using digital tools was an effective method to increase coverage of ITNs while closely tracking the progress of distribution campaigns. High-quality population data are needed to further improve the planning and implementation of ITN campaigns and other health interventions.

Emergency infection prevention and control training in fragile, conflict-affected or vulnerable settings: a scoping review

BACKGROUND

It is uncertain what could be the best training methods for infection prevention and control when an infectious disease threat is active or imminent in especially vulnerable or resource-scarce settings.

METHODS

A scoping review was undertaken to find and summarise relevant information about training modalities, replicability and effectiveness of IPC training programmes for clinical staff as reported in multiple study designs. Eligible settings were conflict-affected or in countries classified as low-income or lower-middle income (World Bank 2022 classifications). Search terms for LILACS and Scopus were developed with input of an expert working group. Initially found articles were dual-screened independently, data were extracted especially about infection threat, training outcomes, needs assessment and teaching modalities. Backwards and forwards citation searches were done to find additional studies. Narrative summary describes outcomes and aspects of the training programmes. A customised quality assessment tool was developed to describe whether each study could be informative for developing specific future training programmes in relevant vulnerable settings, based on six questions about replicability and eight questions about other biases.

FINDINGS

Included studies numbered 29, almost all (n = 27) were pre-post design, two were trials. Information within the included studies to enable replicability was low (average score 3.7/6). Nearly all studies reported significant improvement in outcomes suggesting that the predominant study design (pre-post) is inadequate to assess improvement with low bias, that any and all such training is beneficial, or that publication bias prevented reporting of less successful interventions and thus a informative overview.

CONCLUSION

It seems likely that many possible training formats and methods can lead to improved worker knowledge, skills and / or practice in infection prevention and control. Definitive evidence in favour of any specific training format or method is hard to demonstrate due to incomplete descriptions, lack of documentation about unsuccessful training, and few least-biased study designs (experimental trials). Our results suggest that there is a significant opportunity to design experiments that could give insights in favour of or against specific training methods. "Sleeping" protocols for randomised controlled trials could be developed and then applied quickly when relevant future events arise, with evaluation for outcomes such as knowledge, practices, skills, confidence, and awareness.

"Endless opportunities": A qualitative exploration of facilitators and barriers to scale-up of two-way texting follow-up after voluntary medical male circumcision in Zimbabwe

In Zimbabwe, the ZAZIC consortium employs two-way, text-based (2wT) follow-up to strengthen post-operative care for voluntary medical male circumcision (VMMC). 2wT scaled nationally with evidence of client support and strengthened follow-up. However, 2wT uptake among healthcare providers remains suboptimal. Understanding the gap between mobile health (mHealth) potential for innovation expansion and scale-up realization is critical for 2wT and other mHealth innovations. Therefore, we conducted an exploratory qualitative study with the objective of identifying 2wT program strengths, challenges, and suggestions for scale up as part of routine VMMC services. A total of 16 in-depth interviews (IDIs) with diverse 2wT stakeholders were conducted, including nurses, monitoring & evaluation teams, and technology partners-a combination of perspectives that provide new insights. We used both inductive and deductive coding for thematic analysis. Among 2wT drivers of expansion success, interviewees noted: 2wT care benefits for clients; effective hands-on 2wT training; ease of app use for providers; 2wT saved time and money; and 2wT strengthened client/provider interaction. For 2wT scale-up challenges, staff shortages; network infrastructure constraints; client costs; duplication of paper and electronic reporting; and complexity of digital tools integration. To improve 2wT robustness, respondents suggested: more staff training to offset turnover; making 2wT free for clients; using 2wT to replace paper VMMC reporting; integrating with routine VMMC reporting systems; and expanding 2wT to other health areas. High stakeholder participation in app design, implementation strengthening, and evaluation were appreciated. Several 2wT improvements stemmed from this study, including enrollment of multiple people on one number to account for phone sharing; 2wT inclusion of minors ages 15+; clients provided with $1 to offset SMS costs; and reduced SMS messages to clients. Continued 2wT mentoring for staff, harmonization of 2wT with Ministry e-health data systems, and increased awareness of 2wT's client and provider benefits will help ensure successful 2wT scale-up.

On-demand mobile hypertension training for primary health care workers in Nigeria: a pilot study

BACKGROUND

Only one out of every ten Nigerian adults with hypertension has their blood pressure controlled. Health worker training is essential to improve hypertension diagnosis and treatment. In-person training has limitations that mobile, on-demand training might address. This pilot study evaluated a self-paced, case-based, mobile-optimized online training to diagnose and manage hypertension for Nigerian health workers.

METHODS

Twelve hypertension training modules were developed, based on World Health Organization and Nigerian guidelines. After review by local academic and government partners, the course was piloted by Nigerian health workers at government-owned primary health centers. Primary care physician, nurse, and community health worker participants completed the course on their own smartphones. Before and after the course, hypertension knowledge was evaluated with multiple-choice questions. Learners provided feedback by responding to questions on a Likert scale.

RESULTS

Out of 748 users who sampled the course, 574 enrolled, of whom 431 (75%) completed the course. The average pre-test score of completers was 65.4%, which increased to 78.2% on the post-test (P < 0.001, paired t-test). Health workers who were not part of existing hypertension control programs had lower pre-test scores and larger score gains. Most participants (96.1%) agreed that the training was applicable to their work, and nearly all (99.8%) agreed that they enjoyed the training.

CONCLUSIONS

An on-demand mobile digital hypertension training increases knowledge of hypertension management among Nigerian health workers. If offered at scale, such courses can be a tool to build health workforce capacity through initial and refresher training on current clinical guidelines in hypertension and other chronic diseases in Nigeria as well as other countries.

Training a Continent: A Process Evaluation of Virtual Training on Infection Prevention and Control in Africa During COVID-19

BACKGROUND

Strengthening infection prevention and control (IPC) capacity was identified as a key intervention to prepare African Union member states to curb the COVID-19 pandemic. As part of the Africa Taskforce for Coronavirus, which helped implement the Africa Joint Continental Strategy for COVID-19 Outbreak response, the IPC Technical Working Group (IPC TWG) was convened to coordinate the development of IPC core components for preparedness, response, and recovery from COVID-19. As part of the IPC TWG's work, the Africa Centres for Disease Control and Prevention, in collaboration with the Infection Control Africa Network, delivered virtual IPC training sessions targeted to African Union member states. We aimed to undertake a process evaluation of this training to inform and improve both ongoing and future programming.

METHODS

The scope of the evaluation was agreed upon through discussion with the training organizers and advisory members and a design workshop. A mixed-methods approach was used; data collection was partly prospective and partly retrospective due to the rapid start of some of the training activities. Existing available data included: usage analytics, the content of questions posed during the webinar and community of practice, and participant feedback survey results. In addition, in-depth qualitative interviews were conducted with a sample of webinar participants.

RESULTS

The rapid development of this training was efficient and responsive. The training reached more than 3,000 participants across the 2 rounds, but the numbers varied substantially by location. Participants engaged well during the question period during each webinar, but the asynchronous community of practice was less utilized during the evaluation time frame. Many participants appreciated the African focus of the webinars and gave positive feedback on the practical and context-specific content.

CONCLUSIONS

The move toward online training provides an important opportunity to improve IPC across the African continent.