JMIR Publications

ABSTRACT

Background:

The Extension for Community Health Outcomes (ECHO) model was adapted for hypertension education of community health extension workers (CHEWs) in the Federal Capital Territory (FCT), Nigeria and delivered as a seven-part series.

Objective:

Our objective was to evaluate Kirkpatrick and implementation outcomes of the hypertension ECHO series. Kirkpatrick outcomes included reaction (level 1), learning (level 2), and behavior (level 3). Implementation outcomes included reach, appropriateness, effectiveness, and penetration.

Methods:

From August 2022 to April 2023, seven zoom-based hypertension ECHO sessions were delivered to a diverse healthcare worker (HCW) audience including targeted CHEWs at 12 Primary Health Centers (PHCs) in the Hypertension Treatment in Nigeria Program. HCWs provided demographic information, engaged in pre- and post- knowledge quizzes, and shared feedback during live sessions. Surveys were sent to HCWs at 12 PHCs approximately one-month after each session to ask about utilization of the presented material, and focus group discussions (FGDs) were performed with these HCWs after the ECHO program concluded. Qualitative and quantitative results were evaluated using a convergent parallel mixed methods design.

Results:

Across seven ECHO sessions, a total of 1407 live participants were documented. Reaction (level 1) to each session was positive, with >97% of respondents reporting that the session was useful, and post-session knowledge (level 2) scores increased (range: 2.3% to 10.5%) relative to pre-session scores. Among 12 PHCs, most (>70%) HCWs applied information learned in each session to provide patient care (level 3). In six FGDs, with 31 HCWs (48% CHEWs), participants reported that network connectivity and clinical demands were barriers to live participation and expressed preferences for blended training and asynchronous resources.

Conclusions:

Results show that a hypertension ECHO program adapted for CHEWs increased knowledge among participants, and was useful to a majority. Insights gained may inform scaling of remote hypertension education programs for CHEWs in similar settings. Clinical Trial: The Hypertension Treatment in Nigeria Program was prospectively registered on November 8, 2019 with Clinical Trials.gov (NCT04158154).