JMIR Publications

ABSTRACT

Background:

The shortage and disproportionate distribution of healthcare workers worldwide is further aggravated by the inadequacy of training programmes, difficulties in implementing conventional curricula, deficiencies in learning infrastructure, or a lack of essential equipment/supplies. Offline digital education has the potential to reduce the shortage and improve the quality of education.

Objective:

The primary objective of this systematic review (SR) was to evaluate the effectiveness of offline digital education compared with various controls in improving learners’ knowledge, skills, attitudes, satisfaction; and patient-related outcomes. The secondary objectives were (i) to assess cost-effectiveness of the interventions and (iii) to assess adverse effects of the interventions on patients and learners.

Methods:

We searched seven electronic databases and two trial registers for randomized controlled trials published between January 1990 and August 2017. We used gold standard Cochrane methods to select and extract data and to appraise eligible studies.

Results:

A total of 27 trials involving 4618 individuals were included in this systematic review. Meta-analyses found that compared with no intervention, offline digital education (CD-ROM) may increase knowledge in nurses (SMD 1.88 [95% CI 1.14, 2.62]; participants = 300; studies = 3; I2 = 80%, low certainty evidence). Meta-analysis of two studies found that compared with traditional learning, the PowerPoint Presentation may improve knowledge of patient care personnel and pharmacists (SMD 0.76 [95% CI 0.29, 1.23]; participants = 167; I2 = 54%, low certainty evidence). Meta-analysis of four studies found that compared with traditional training, the effects of computer assisted training on skills in community (mental health) therapists, nurses and pharmacists, were uncertain (SMD 0.45 [95% CI -0.35, 1.25]; participants = 229, very low certainty evidence). Meta-analysis of four studies found that compared with traditional training, offline digital education may have little effect or no difference on satisfaction scores in nurses, and mental health therapists (SMD -0.07 95% CI -0.42, 0.28], participants = 232; I2 = 41%, low certainty evidence). Two studies found that offline digital education may have little or no effect on patient-centered outcomes when compared with blended learning. For skills and attitudes the results were mixed and inconclusive. None of the studies reported adverse of unintended effects of the interventions. Only one study reported costs of interventions. The risk of bias was predominantly unclear; and the certainty of the evidence ranged from low or very low.

Conclusions:

There is some evidence to support the effectiveness of offline digital education in improving learners’ knowledge; and insufficient quality and quantity evidence for the other outcomes. Future, high quality studies are needed to further increase generalizability and inform practitioners and policymakers. Clinical Trial: n/a