JMIR Publications

ABSTRACT

Background:

Community health workers (CHWs) play an important role in delivering essential health services in low- and middle-income countries (LMICs). Training CHWs using digital approaches is on the rise. However, important questions remain about digital training optimization and outcomes.

Objective:

This review describes the characteristics of digital training for CHWs and their impact on health services in LMICs.

Methods:

A scoping review approach based on Arksey and O’Malley’s guiding principles was used to retrieve, review, and analyze existing literature. We searched ten foremost databases using keywords and Medical Subject Headings terms for CHWs, LMIC, and digital learning to identify primary, peer-reviewed studies published through November 2024. Articles that focused on the provision of digital training for CHWs working in LMICs in any disease domain evaluating a learning, implementation, or clinical outcome met the inclusion criteria. Study details, study designs, training attributes, technology and CHW descriptions, and outcomes were abstracted. The PRISMA guidelines for reporting scoping reviews were used.

Results:

A total of 699 articles were retrieved and screened for eligibility, of which 18 original articles met the inclusion criteria. Most (n=13) were conducted in Asia. Most (n=15) used non-randomized study designs. The most common attributes included: synchronous (n=8), accessible in the community (n=12), use of smartphones (n=7) and training videos (n=14), and accessible online (n=9). Majority reported learning outcomes (n=14), half reported implementation outcomes (n=9), and only one reported clinical outcomes (n=1). The learning outcomes focused on knowledge gained and were mostly positive. The implementation outcomes included CHW’s acceptability and feasibility to use the digital training approach. The clinical outcome was effectiveness.

Conclusions:

Few identified studies met eligibility for inclusion. Majority of the studies were positive, focused on knowledge gained but non-randomized and failed to evaluate implementation or clinical outcomes. Further research should use rigorous designs to focus on implementation and clinical outcomes to ensure that a better understanding of whether and how to use digital learning for these CHWs in LMIC.