JMIR Publications

ABSTRACT

Background:

Community health workers (CHWs) play a vital role in delivering pediatric care in resource-limited settings, yet evidence on acceptable approaches for recurrent training remains limited. Mobile health (mHealth) training tools have demonstrated promise in enhancing skill acquisition and retention among CHWs; however, little is known about which specific design features optimize learning and sustained use over time.

Objective:

This study evaluates learning outcomes, engagement patterns, and user experiences associated with three mHealth training modalities for CHWs in Northern Uganda.

Methods:

We conducted a convergent mixed methods study within an established community-led CHW training program. Over eight months, CHWs in Northern Uganda were assigned to one of three mHealth training approaches: 1) a standard self-guided tablet application (‘standard’ group), 2) a gamified application with assessment-gated progression (‘gamified’ group), and 3) the standard application supplemented with simulation-based training (‘standard + simulation’ group). Quantitative outcomes included 1) written multiple-choice exams at baseline (T1), two months (T2), and eight months (T3), with competency defined as scores >80%, 2) a clinical skills assessment at eight months, and 3) tablet engagement analytics, including video views, in-quiz attempts, and quiz scores. Qualitative data were collected through semi-structured interviews and analyzed thematically. Quantitative and qualitative findings were integrated using joint displays.

Results:

Out of 30 eligible CHWs approached, all agreed to participate. Over the study period, six CHWs left the training program and were excluded from all analyses; the remaining 24 CHWs completed qualitative interviews and were included in tablet engagement analyses (standard: N=8; gamified: N=10; standard + simulation: N=6). 21 CHWs completed written exams at all three timepoints and were included in exam score analyses. Median written exam scores improved in the overall sample, increasing from 73% (IQR 26.67) at baseline (T1) to 100% (IQR 6.67) at eight months (T3) (p < 0.001), with no differences in the median magnitude of score improvement observed across training modalities (16.67 vs. 26.67 vs 26.67, p=0.64). All CHWs demonstrated competency in advanced pediatric clinical skills at study completion. The gamified application was associated with higher rates of video viewing and in-app quiz attempts per active day but did not result in higher in-app quiz pass rates or final exam scores compared with the standard application. Those who received the simulation reported greater confidence and perceived preparedness despite similar quantitative performance. Engagement declined modestly over time (from 77% to 58% of CHWs engaged weekly), consistent with qualitative reports of time constraints and technical barriers, including limited access to electricity for tablet charging.

Conclusions:

Findings suggest that mHealth-supported training can facilitate sustained acquisition of advanced pediatric clinical skills among experienced CHWs in a rural, resource-limited setting. These findings can inform the user-centered design of future training interventions.