JMIR Publications

ABSTRACT

Background:

While smartphone-based clinical training to support emergency care training is more affordable than traditional avenues of training, it is still in its infancy, remains poorly implemented, and current implementations tend to be invariant to the evolving learning needs of the intended users. In resource-limited settings, the use of such platforms coupled with serious-gaming approaches remain largely unexplored and under-developed even though they offer promise of helping to addressing the health workforce skill imbalance and lack of training opportunities associated with the high neonatal mortality rates in these settings.

Objective:

This randomised experiment aims to assess the effectiveness of offering adaptive versus standard feedback through a smartphone-based serious game on healthcare providers’ knowledge gains on the management of a neonatal medical emergency.

Methods:

The experiment is aimed at healthcare workers (physicians, nurses and clinical officers) who provide bedside neonatal care in low-income settings. We will use data captured through an Android smartphone-based serious-game application that will be downloaded to personal phones belonging to the study participants, with the intervention being adaptive feedback provided within the application. The data captured will include the level of feedback provided to participants as they learn using the mobile application and performance data from attempts made at assessments questions on interactive tasks they perform as they progress through the application on emergency neonatal care delivery. The primary endpoint will be the first two complete rounds of learning within the application from which the individuals’ ‘learning gain’ and Morris G intervention effect size will be computed. To minimise bias, participants will be assigned to experimental or control group by a within-application random generator, with this process being concealed to both the study participants and the investigators until the primary endpoint is reached.

Results:

This project was funded in November 2016. It has been approved by the Central University Research Ethics Committee of the University of Oxford together with the Scientific and Ethics Review Unit of the Kenya Medical Research Institute. Recruitment and data collection began from February 2019 and will be up to July 2019. As of April 2019, we had enrolled 284 participants, of whom 121 had reached the primary endpoint, with a further 19 qualitative interviews conducted to support evaluation. Full analysis will be conducted once the minimum 166 required participants are recruited.

Conclusions:

This study will be used to explore the effectiveness of adaptive feedback in a smartphone-based serious game on healthcare providers in a low-income setting. This aspect of medical education is a largely unexplored topic in this context. In this randomised experiment, the risk of performance bias across arms is moderate given the active ingredient of the intervention (i.e. knowledge) is a latent trait that is difficult to comprehensively control for in a real-world setting. However, the influence of any resulting bias in its ability to alter results will be assessed within the study using alternative methods such as qualitative interviews. Clinical Trial: www.pactr.org PACTR201901783811130