Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Sep 7, 2020
Date Accepted: Aug 1, 2021
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Acceptability and potential effectiveness of eHealth tools for training primary health workers at scale: a mixed-methods, uncontrolled before and after study from Nigeria
ABSTRACT
Background:
In-service training of frontline health workers (FHWs) in primary health care (PHC) facilities plays an important role in improving the standard of healthcare delivery. However, it is often expensive and requires FHWs to leave their posts in rural areas to attend courses in urban centres. This paper reports the implementation of a digital health tool for video training (VTR) on maternal, newborn and child health (MNCH) to provide in-service training at scale without interrupting health services.
Objective:
This study aimed to determine the feasibility and acceptability of these tools, and their potential effectiveness at improving FHWs’ clinical knowledge, attitudes and reported practices related to MNCH care.
Methods:
An uncontrolled pre-post design was adopted. From October 2017 to May 2018, the VTR Mobile intervention was delivered to FHWs in three states of Nigeria. We examined changes in workers’ knowledge and confidence to deliver MNCH services through a pre- and post-test survey. Stakeholder experiences of the intervention were explored through semi-structured interviews drawing on the technology acceptance model to frame contextual factors shaping its acceptability and usability in the work environment.
Results:
In total, 328 FHWs completed both a pre- and post-test. FHWs achieved a mean pre-test score of 51% (95% CI: 48, 54) and a mean post-test score of 69% (95% CI: 66, 72). After adjusting for key covariates this represented a mean increase in test score, between the pre- and post-test, of 17 percentage points (95% CI: 15, 19; P < 0.001). Variation was identified in pre- and post-test score differences by the sex and location of participants alongside topic-specific areas where scoring was lowest. Stakeholder interviews suggested wide acceptance of VTR Mobile delivered via digital technology as an important tool for enhancing the quality of training, reinforcing knowledge, and improving health outcomes.
Conclusions:
This study determined that video training, supported through a digital technology approach, is a feasible and acceptable approach for supporting improvements in clinical knowledge, attitudes and reported practices in MNCH. The evaluation also identified the mechanisms of impact of delivering VTR Mobile at scale on micro (individual), meso (organizational) and macro (policy) levels of the health system. Future research is required to explore the translation of this digital health tool for video training of FHWs and its impact across low resource settings to ameliorate financial and time costs of training and support the delivery of high-quality MNCH care. Clinical Trial: ISRCTN32105372
Citation
