@Article{info:doi/10.2196/65042, author="Khlaif, Zuheir and Salama, Nisreen and Hamamra, Bilal and Mousa, Allam", title="Factors Influencing Educators' Perspectives on Accepting Extended Reality in Health Care Education: Qualitative Study", journal="JMIR Med Educ", year="2025", month="May", day="1", volume="11", pages="e65042", keywords="extended reality (XR)", keywords="health care education", keywords="educational technology", keywords="Sustainable Development Goals (SDGs)", keywords="Palestine", abstract="Background: Palestinian higher education institutions face limitations in providing interactive practical training for medical education. Extended reality (XR), which encompasses virtual reality and augmented reality, is increasingly recognized for addressing these challenges by offering immersive learning experiences. Objective: This study investigates the factors influencing the acceptance and adoption of XR in health care education within Palestinian universities, exploring its potential to transform traditional teaching methods. Methods: A qualitative approach was used in this study to collect data through semistructured interviews and artifacts from the participants. The participants of the study were 25 faculty members from 2 large Palestinian universities who teach in the field of medical sciences. Results: Three primary categories---external, internal, and design-related factors---emerged as pivotal in influencing XR adoption. Professional development, technical support, and infrastructure were key external enablers. Internally, prior experience with digital tools and positive attitudes had a significant impact on the adoption of XR. Design factors, including ease of use and interactivity, played a crucial role but also posed challenges for less tech-savvy educators. Despite barriers such as cost and technical issues, XR demonstrated notable benefits, including enhanced learning outcomes, improved knowledge retention, and the ability to simulate complex medical scenarios. Conclusions: XR technologies offer transformative potential for health care education in Palestine. By addressing challenges and leveraging XR's strengths, educational institutions can foster innovation and improve student engagement and skill acquisition. The study contributes to the theoretical understanding of technology acceptance in education by identifying the interplay of external, internal, and design factors. Practically, it emphasizes strategic investments in infrastructure, professional training, and institutional policies to optimize XR integration. ", doi="10.2196/65042", url="https://mededu.jmir.org/2025/1/e65042", url="http://www.ncbi.nlm.nih.gov/pubmed/40310667" } @Article{info:doi/10.2196/45912, author="Herman, Patricia and M Kibusi, Stephen and C Millanzi, Walter", title="Effectiveness of an Interactive Web-Based Clinical Practice Monitoring System on Enhancing Motivation in Clinical Learning Among Undergraduate Nursing Students: Longitudinal Quasi-Experimental Study in Tanzania", journal="JMIR Med Educ", year="2025", month="Apr", day="23", volume="11", pages="e45912", keywords="clinical monitoring system", keywords="clinical practice", keywords="motivation in clinical learning", keywords="nursing students", keywords="smartphone", keywords="mobile phone", keywords="Ruaha Catholic University", keywords="web-based teaching", abstract="Background: Nursing students' motivation in clinical learning is very important not only for their academic and professional achievement but also for making timely, informed, and appropriate decisions in providing quality and cost-effective care to people. However, the increased number of students and the scarcity of medical supplies, equipment, and patients, just to mention a few, have posed a challenge to educators in identifying and navigating the best approaches to motivate nursing students to learn during their clinical placements. Objective: This study primarily used descriptive and analytical methods to examine undergraduate nursing students' desire for clinical learning both before and after participating in the program. Methods: An uncontrolled longitudinal quasi-experimental study in a quantitative research approach was conducted from February to March 2021 among 589 undergraduate nursing students in Tanzania. Following a baseline evaluation, nursing students were enrolled in an interactive web-based clinical practice monitoring system by their program, institution, names, registration numbers, and emails via unique codes created by the lead investigator and trainers. The system recorded and generated feedback on attendance, clinical placement unit, selected or performed clinical nursing procedures, and in-between and end-of-shift feedback. The linear regression was used to assess the effect of the intervention (interactive web-based clinical practice monitoring system) controlled for other correlated factors on motivation in clinical learning (outcome) among nursing students. Nursing students' sociodemographic characteristics and levels of motivation in clinical learning were analyzed descriptively while a 2-tailed paired sample t test established a comparative mean difference in motivation in clinical learning between the pretest and the posttest. The association between variables was determined using regression analysis set at a 95\% CI and 5\% statistical significance. Results: The mean age of study participants (N=589) was 23 (SD 2.69) years of which 383 (65.0\%) were male. The estimated effect ($\beta$) of a 3-week intervention to improve nursing students' motivation in clinical learning was 3.041 (P=.03, 95\% CI 1.022-7.732) when controlled for other co-related factors. The mean score for motivation in clinical learning increased significantly from the baseline (mean 9.31, SD 2.315) to the postintervention (mean 20.87, SD 5.504), and this improvement presented a large effect size of 2.743 (P<.001, 95\% CI 1.011-4.107). Conclusions: Findings suggest that an interactive web-based clinical practice monitoring system is viable and has the potential to improve undergraduate nursing students' motivation for clinical learning. One alternative clinical pedagogy that educators in nursing education can use to facilitate clinical learning activities and develop motivated undergraduate nursing students is the integration of such technology throughout nursing curricula. ", doi="10.2196/45912", url="https://mededu.jmir.org/2025/1/e45912" } @Article{info:doi/10.2196/62741, author="Mbeya-Munkhondya, E. Tiwonge and Meek, J. Caroline and Mphande, Mtisunge and Tembo, A. Tapiwa and Chitani, J. Mike and Jean-Baptiste, Milenka and Kumbuyo, Caroline and Vansia, Dhrutika and Simon, R. Katherine and Rutstein, E. Sarah and Mwapasa, Victor and Go, Vivian and Kim, H. Maria and Rosenberg, E. Nora", title="Anticipated Acceptability of Blended Learning Among Lay Health Care Workers in Malawi: Qualitative Analysis Guided by the Technology Acceptance Model", journal="JMIR Form Res", year="2025", month="Apr", day="7", volume="9", pages="e62741", keywords="blended learning", keywords="technology acceptance model", keywords="index case testing", keywords="acceptability", keywords="partner notification", keywords="contact tracing", abstract="Background: HIV index case testing (ICT) aims to identify people living with HIV and their contacts, engage them in HIV testing services, and link them to care. ICT implementation has faced challenges in Malawi due to limited counseling capacity among lay health care workers (HCWs). Enhancing capacity through centralized face-to-face training is logistically complex and expensive. A decentralized blended learning approach to HCW capacity-building, combining synchronous face-to-face and asynchronous digital modalities, may be an acceptable way to address this challenge. Objective: The objective of this analysis is to describe factors influencing HCW anticipated acceptability of blended learning using the Technology Acceptance Model (TAM). Methods: This formative qualitative study involved conducting 26 in-depth interviews with HCWs involved in the ICT program across 14 facilities in Machinga and Balaka, Malawi (November-December 2021). Results were analyzed thematically using TAM. Themes were grouped into factors affecting the 2 sets of TAM constructs: perceived usefulness and perceived ease of use. Results: A total of 2 factors influenced perceived usefulness. First, HCWs found the idea of self-guided digital learning appealing, as they believed it would allow for reinforcement, which would facilitate competence. They also articulated the need for opportunities to practice and receive feedback through face-to-face interactions in order to apply the digital components. In total, 5 factors influenced perceived ease of use. First, HCWs expressed a need for orientation to the digital technology given limited digital literacy. Second, they requested accessibility of devices provided by their employer, as many lacked personal devices. Third, they wished for adequate communication surrounding their training schedules, especially if they were going to be asynchronous. Fourth, they wished for support for logistical arrangements to avoid work interruptions. Finally, they wanted monetary compensation to motivate learning, a practice comparable with offsite trainings. Conclusions: A decentralized blended learning approach may be an acceptable method of enhancing ICT knowledge and skills among lay HCWs in Malawi, although a broad range of external factors need to be considered. Our next step is to integrate these findings into a blended learning package and examine perceived acceptability of the package in the context of a cluster randomized controlled trial. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2023-077706 ", doi="10.2196/62741", url="https://formative.jmir.org/2025/1/e62741" } @Article{info:doi/10.2196/63309, author="Abdul Hamid Alhassan, Hajia Ramatu and Haggerty, L. Catherine and Fapohunda, Abimbola and Affan, Jabir Nabeeha and Anto-Ocrah, Martina", title="Exploring the Use of Digital Educational Tools for Sexual and Reproductive Health in Sub-Saharan Africa: Systematic Review", journal="JMIR Public Health Surveill", year="2025", month="Feb", day="26", volume="11", pages="e63309", keywords="digital health", keywords="adolescents", keywords="Africa", keywords="sexual health", keywords="reproductive health", keywords="human-centered design", abstract="Background: Adolescents, particularly those in Sub-Saharan Africa, experience major challenges in getting accurate and comprehensive sexual and reproductive health (SRH) information because of sociocultural norms, stigma, and limited SRH educational resources. Digital educational tools, leveraging the widespread use of mobile phones and internet connectivity, present a promising avenue to overcome these barriers and enhance SRH education among adolescents in Sub-Saharan Africa. Objective: We conducted a systematic review to describe (1) the geographic and demographic distributions (designated objectives 1a and 1b, respectively, given their interrelatedness) and (2) the types and relevant impacts of digital educational tools (objective 2). Methods: We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using databases, such as Ovid-MEDLINE, Google Scholar, PubMed, and ERIC, to conduct literature searches. The selection criteria focused on studies that specifically addressed digital educational tools used to assess or deliver SRH education, their implementation, and their effectiveness among the adolescent population in Sub-Saharan Africa. We used the JBI critical appraisal tools for the quality assessment of papers included in the review. Results: The review identified 22 studies across Sub-Saharan Africa that met the inclusion criteria. The 22 studies spanned populations in West, Central, East, and South Africa, with an emphasis on youth and adolescents aged 10-24 years, reflecting the critical importance of reaching these age groups with effective, accessible, and engaging health education (objectives 1a and 1b). There was a diverse range of digital tools used, including social media platforms, mobile apps, and gamified learning experiences, for a broad age range of adolescent youth. These methods were generally successful in engaging adolescents by providing them with accessible and relevant SRH information (objective 2). However, challenges, such as the digital divide, the cultural sensitivity of the material, and the necessity for a thorough examination of the long-term influence of these tools on behavior modification, were noted. Conclusions: Digital educational tools provide great potential to improve SRH education among adolescents in Sub-Saharan Africa. These technologies can help enhance relevant health outcomes and accessibility by delivering information that is easy to understand, interesting, and tailored to their needs. Future research should focus on addressing the identified challenges, including bridging the digital divide, ensuring cultural and contextual relevance of content, and assessing the long-term impact of digital SRH education on adolescent behavior and health outcomes. Policymakers and educators are encouraged to integrate digital tools into SRH educational strategies that target adolescents in order to improve the SRH of this age group and contribute to improving public health in Sub-Saharan Africa. ", doi="10.2196/63309", url="https://publichealth.jmir.org/2025/1/e63309", url="http://www.ncbi.nlm.nih.gov/pubmed/40009849" } @Article{info:doi/10.2196/63480, author="Basheer N, Amitha and Jodalli, Praveen and Shetty, Shishir and Shenoy, Ramya and Rao, Ashwini and Pai, Mithun and Gowdar, Murugendrappa Inderjit and Almalki, Abdulrahman Sultan", title="Development and Validation of the ``Basic Oral Health Assessment Tool'' (BOHAT) for Nondental Health Care Professionals to Use With the Indian Adult Population: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2025", month="Feb", day="13", volume="14", pages="e63480", keywords="oral health assessment tool", keywords="oral health", keywords="screening", keywords="nondental health care professionals", keywords="primary health centers", keywords="India", keywords="tool validation", keywords="health care training", keywords="mixed methods research", abstract="Background: Oral health is a significant indicator of general health, well-being, and quality of life. The prevention of oral health problems requires periodic inspection of the oral cavity. Routine oral health examinations at the individual level appears to be one way to deliver quality oral health care but are too often missed as an opportunity for improved oral health in the nondental health care setting in India. This is because of limited training and inaccessible or lack of specialized oral health assessment tools. Objective: This study will focus on the development, validation, and implementation of the Basic Oral Health Assessment Tool (BOHAT) to improve the oral health assessment capabilities of nondental health care professionals and thus contribute to improved overall health outcomes of the Indian adult population. Methods: This study will be a mixed methods, multistage study conducted in 3 stages. The study will be conducted with 708 nondental health care professionals in 33 Primary Health Centers (PHCs) of Mangalore Taluk, Karnataka. Ethical approval was sought from the institutional ethics committee of Manipal College of Dental Sciences Mangalore. Informed consent will be obtained from every participant prior to the study. A literature review and qualitative interviews will be used for item and domain generation with respect to BOHAT, and an expert panel review and pilot testing will be used to refine the items and domains. Finally, statistical analyses will be conducted to validate the reliability and consistency. The second phase will involve capacity building and user experience exploration through comprehensive training for nondental health professionals using audio and visual aids, with hands-on learning methodologies including relevant feedback processes in the form of focus group discussions. The third stage will check the effectiveness of BOHAT regarding the changes in knowledge, attitudes, and practices through pre- and posttraining questionnaires, which will then be followed by a retention analysis 3 months later. Results: As of January 20, 2025, the study is in its preliminary phase: ``Substage A: Item and Domain\enspaceDevelopment.'' We have received institutional ethics committee and Institutional Protocol Approval Committee approval for the study. Data collection procedures have not started yet. The study is progressing as per the planned timeline. Conclusions: The BOHAT study holds considerable potential to promote oral health care through collaborative and interdisciplinary approaches. It will facilitate early diagnosis, timely referrals, and comprehensive care by integrating assessment actions for oral health into routine practices of nondental primary health care professionals. International Registered Report Identifier (IRRID): PRR1-10.2196/63480 ", doi="10.2196/63480", url="https://www.researchprotocols.org/2025/1/e63480" } @Article{info:doi/10.2196/58624, author="Reynolds, W. Christopher and Lee, HaEun and Sieka, Joseph and Perosky, Joseph and Lori, R. Jody", title="Implementation of a Technology-Based Mobile Obstetric Referral Emergency System (MORES): Qualitative Assessment of Health Workers in Rural Liberia", journal="JMIR Mhealth Uhealth", year="2024", month="Nov", day="13", volume="12", pages="e58624", keywords="mHealth", keywords="mobile triage", keywords="referral pathways", keywords="Liberia", keywords="LMIC", keywords="low- income country", keywords="obstetric triage", keywords="third delay", keywords="mobile health", keywords="mobile application", keywords="digital health", keywords="digital intervention", keywords="smartphone", keywords="middle-income country", abstract="Background: Maternal mortality remains a persistent challenge in low- and middle-income countries, where evidence-based interventions of obstetric triage and prehospital communication remain sparse. There is limited implementation evidence for technology-based approaches to improve obstetric care in such contexts. Liberia struggles with maternal mortality, particularly in rural areas where deaths are attributable to delays from absent triage and interfacility communication. We implemented a Mobile Obstetric Referral Emergency System (MORES) in rural Bong County to improve prehospital transfer, health worker attentiveness, and patient care for critical obstetric patients. MORES consisted of triage training and a 2-way, templated WhatsApp communication system to reduce delays among patients transferred from rural health facilities (RHF) to hospitals. Objective: This study aimed to examine MORES implementation outcomes of usability, fidelity, effectiveness, sustainability, and scalability, as well as additional impacts on the wider health system. Methods: A structured case study design interview was developed by Liberian and US experts in obstetric triage. Participants included 62 frontline obstetric health providers including midwives (38/62, 61\%), nurses (20/62, 32\%), physicians assistants (3/62, 5\%), and physicians (1/62, 2\%) from 19 RHFs and 2 district hospitals who had used MORES for 1 year. Individual interviews were conducted on MORES implementation outcomes, transcribed, and analyzed in NVivo (version 12; Lumivero) with a team-based coding methodology. Content analysis with a deductive approach examined implementation outcomes of usability, fidelity, effectiveness, sustainability, and scalability, while an inductive approach categorized the unanticipated impacts of MORES on the wider health system. Results: Four domains were identified regarding MORES implementation: Usability and Fidelity, Effectiveness, Sustainability and Scalability, and Health System Impact. All participants perceived MORES to have high usability and fidelity, as the triage and messaging system was implemented as intended for critical obstetric patients (62/62, 100\%). For effectiveness, MORES accomplished its intended aims by improving prehospital transfer (57/62, 92\%), increasing health worker attentiveness (39/62, 63\%), and contributing to improved patient care (34/62, 55\%). MORES was perceived as sustainable and scalable (62/62, 100\%), particularly if technological barriers (21/62, 34\%) and staff training (19/62, 31\%) were addressed. MORES impacted the wider health system in unanticipated ways including improved coordination and accountability (55/62, 89\%), feedback mechanisms for hospitals and RHFs (48/62, 77\%), interprofessional teamwork (21/62, 34\%), longitudinal follow-up care (20/62, 32\%), creating a record of care delays (17/62, 27\%), and electronic health record infrastructure (13/62, 21\%). Conclusions: MORES was perceived to have high usability, fidelity, effectiveness, sustainability, and scalability by frontline obstetric providers in rural Liberia. MORES accomplished the intended aims of improving prehospital transfer, increasing health worker attentiveness, and contributing to improved patient care. Additionally, MORES strengthened the health system through 6 domains which impacted individual and system levels. Future studies should quantitatively evaluate delay and morbidity reductions and strategies for scaling MORES. ", doi="10.2196/58624", url="https://mhealth.jmir.org/2024/1/e58624" } @Article{info:doi/10.2196/53151, author="Sahyouni, Amal and Zoukar, Imad and Dashash, Mayssoon", title="Evaluating the Effectiveness of an Online Course on Pediatric Malnutrition for Syrian Health Professionals: Qualitative Delphi Study", journal="JMIR Med Educ", year="2024", month="Oct", day="28", volume="10", pages="e53151", keywords="effectiveness", keywords="online course", keywords="pediatric", keywords="malnutrition", keywords="essential competencies", keywords="e-learning", keywords="health professional", keywords="Syria", keywords="pilot study", keywords="acquisition knowledge", abstract="Background: There is a shortage of competent health professionals in managing malnutrition. Online education may be a practical and flexible approach to address this gap. Objective: This study aimed to identify essential competencies and assess the effectiveness of an online course on pediatric malnutrition in improving the knowledge of pediatricians and health professionals. Methods: A focus group (n=5) and Delphi technique (n=21 health professionals) were used to identify 68 essential competencies. An online course consisting of 4 educational modules in Microsoft PowerPoint (Microsoft Corp) slide form with visual aids (photos and videos) was designed and published on the Syrian Virtual University platform website using an asynchronous e-learning system. The course covered definition, classification, epidemiology, anthropometrics, treatment, and consequences. Participants (n=10) completed a pretest of 40 multiple-choice questions, accessed the course, completed a posttest after a specified period, and filled out a questionnaire to measure their attitude and assess their satisfaction. Results: A total of 68 essential competencies were identified, categorized into 3 domains: knowledge (24 competencies), skills (29 competencies), and attitudes (15 competencies). These competencies were further classified based on their focus area: etiology (10 competencies), assessment and diagnosis (21 competencies), and management (37 competencies). Further, 10 volunteers, consisting of 5 pediatricians and 5 health professionals, participated in this study over a 2-week period. A statistically significant increase in knowledge was observed among participants following completion of the online course (pretest mean 24.2, SD 6.1, and posttest mean 35.2, SD 3.3; P<.001). Pediatricians demonstrated higher pre- and posttest scores compared to other health care professionals (all P values were <.05). Prior malnutrition training within the past year positively impacted pretest scores (P=.03). Participants highly rated the course (mean satisfaction score >3.0 on a 5-point Likert scale), with 60\% (6/10) favoring a blended learning approach. Conclusions: In total, 68 essential competencies are required for pediatricians to manage children who are malnourished. The online course effectively improved knowledge acquisition among health care professionals, with high participant satisfaction and approval of the e-learning environment. ", doi="10.2196/53151", url="https://mededu.jmir.org/2024/1/e53151" } @Article{info:doi/10.2196/57313, author="Gudlavalleti, Gaurang Anirudh and Babu, R. Giridhara and Kamalakannan, Sureshkumar and Murthy, S. G. V. and Schaper, C. Nicolaas and van Schayck, P. Onno C.", title="Training of Community Health Workers in Diabetes Lead to Improved Outcomes for Diabetes Screening and Management in Low- and Middle-Income Countries: Protocol for a Systematic Review", journal="JMIR Res Protoc", year="2024", month="Aug", day="21", volume="13", pages="e57313", keywords="community health workers", keywords="diabetes training", keywords="community health worker training", keywords="systematic review", keywords="diabetes management", keywords="community training", keywords="low-and-middle-income countries", keywords="diabetes", keywords="type 2 diabetes mellitus", keywords="prevalence", keywords="rural", keywords="health care professionals", keywords="barriers", abstract="Background: Diabetes is a growing concern worldwide, particularly in low- and middle-income countries (LMICs). Type 2 diabetes mellitus constitutes a significant proportion of cases and is associated with debilitating microvascular complications. Type 2 diabetes mellitus is steadily increasing among the LMICs where many barriers to health care exist. Thus, task shifting to community health workers (CHWs) has been proposed as a solution to improve diabetes management in these settings. However, CHWs often lack the necessary training to manage diabetes effectively. Thus, a systematic review is required to present evidence of the highest degree for this intervention. Objective: This study aims to establish the protocols for a systemic review. Methods: Using the Participants Intervention Comparator Outcome Time Study Design (PICOTS) framework, this study outlines a systematic review aiming to evaluate the impact of training programs for CHWs in diabetes management in LMICs. Quantitative studies focusing on CHWs, diabetes training, focusing on diabetes management outcomes like hemoglobin A1c levels and fasting blood glucose levels, between January 2000 and December 2023 and found on databases such as PubMed, Ovid MEDLINE, Evidence Based Medicine Reviews, BASE, Google Scholar, and Web of Science will be included. We will include randomized controlled trials but will also include observational studies if we find less than 5 randomized controlled trials. An author committee consisting of 3 reviewers will be formed, where 2 reviewers will conduct the review independently while the third will resolve all disputes. The Cochrane Methods Risk of Bias Tool 2 will be used for assessing the risk of bias and the Grading of Recommendations, Assessment, Development and Evaluation approach for the meta-analysis and narrative synthesis analysis will be used. The results will be presented in a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram. Results: The review will begin in May 2024 and conclude in 3 months. Conclusions: The review will synthesize existing evidence and provide insights into the effectiveness of such programs, informing future research and practice in diabetes care in LMICs. Trial Registration: PROSPERO CRD42022341717; https://tinyurl.com/jva2hpdr International Registered Report Identifier (IRRID): PRR1-10.2196/57313 ", doi="10.2196/57313", url="https://www.researchprotocols.org/2024/1/e57313" } @Article{info:doi/10.2196/47127, author="Nguyen, Tuan Ba and Nguyen, Anh Van and Blizzard, Leigh Christopher and Palmer, Andrew and Nguyen, Tu Huu and Quyet, Cong Thang and Tran, Viet and Skinner, Marcus and Perndt, Haydn and Nelson, R. Mark", title="Using the Kirkpatrick Model to Evaluate the Effect of a Primary Trauma Care Course on Health Care Workers' Knowledge, Attitude, and Practice in Two Vietnamese Local Hospitals: Prospective Intervention Study", journal="JMIR Med Educ", year="2024", month="Jul", day="23", volume="10", pages="e47127", keywords="trauma care", keywords="emergency medicine", keywords="primary trauma care course", keywords="short course", keywords="medical education", keywords="trauma", keywords="emergency", keywords="urgent", keywords="professional development", keywords="workshop", keywords="injury", keywords="injured", keywords="injuries", keywords="primary care", abstract="Background: The Primary Trauma Care (PTC) course was originally developed to instruct health care workers in the management of patients with severe injuries in low- and middle-income countries (LMICs) with limited medical resources. PTC has now been taught for more than 25 years. Many studies have demonstrated that the 2-day PTC workshop is useful and informative to frontline health staff and has helped improve knowledge and confidence in trauma management; however, there is little evidence of the effect of the course on changes in clinical practice. The Kirkpatrick model (KM) and the knowledge, attitude, and practice (KAP) model are effective methods to evaluate this question. Objective: The aim of this study was to investigate how the 2-day PTC course impacts the satisfaction, knowledge, and skills of health care workers in 2 Vietnamese hospitals using a conceptual framework incorporating the KAP model and the 4-level KM as evaluation tools. Methods: The PTC course was delivered over 2 days in the emergency departments (EDs) of Thanh Hoa and Ninh Binh hospitals in February and March 2022, respectively. This study followed a prospective pre- and postintervention design. We used validated instruments to assess the participants' satisfaction, knowledge, and skills before, immediately after, and 6 months after course delivery. The Fisher exact test and the Wilcoxon matched-pairs signed rank test were used to compare the percentages and mean scores at the pretest, posttest, and 6-month postcourse follow-up time points among course participants. Results: A total of 80 health care staff members attended the 2-day PTC course and nearly 100\% of the participants were satisfied with the course. At level 2 of the KM (knowledge), the scores on multiple-choice questions and the confidence matrix improved significantly from 60\% to 77\% and from 59\% to 71\%, respectively (P<.001), and these improvements were seen in both subgroups (nurses and doctors). The focus of level 3 was on practice, demonstrating a significant incremental change, with scenarios checklist points increasing from a mean of 5.9 (SD 1.9) to 9.0 (SD 0.9) and bedside clinical checklist points increasing from a mean of 5 (SD 1.5) to 8.3 (SD 0.8) (both P<.001). At the 6-month follow-up, the scores for multiple-choice questions, the confidence matrix, and scenarios checklist all remained unchanged, except for the multiple-choice question score in the nurse subgroup (P=.005). Conclusions: The PTC course undertaken in 2 local hospitals in Vietnam was successful in demonstrating improvements at 3 levels of the KM for ED health care staff. The improvements in the confidence matrix and scenarios checklist were maintained for at least 6 months after the course. PTC courses should be effective in providing and sustaining improvement in knowledge and trauma care practice in other LMICs such as Vietnam. Trial Registration: Australian New Zealand Clinical Trial Registry (ANZCTR) ACTRN 12621000371897; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380970 ", doi="10.2196/47127", url="https://mededu.jmir.org/2024/1/e47127" } @Article{info:doi/10.2196/55297, author="Lule, Herman and Mugerwa, Micheal and Ssebuufu, Robinson and Kyamanywa, Patrick and B{\"a}rnighausen, Till and Posti, P. Jussi and Wilson, Lowery Michael", title="Effect of Rural Trauma Team Development on the Outcomes of Motorcycle Accident--Related Injuries (Motor Registry Project): Protocol for a Multicenter Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="May", day="7", volume="13", pages="e55297", keywords="randomized controlled trial", keywords="medical education", keywords="trauma team", keywords="trauma registry", keywords="rural health", keywords="global health", keywords="team development", keywords="Africa", keywords="rural", keywords="trauma", keywords="motorcycle injury", keywords="multicenter cluster randomized controlled clinical trial", keywords="injury", keywords="accident", keywords="low- and middle-income countries", keywords="patient outcomes", keywords="education program", abstract="Background: Injury is a global health concern, and injury-related mortality disproportionately impacts low- and middle-income countries (LMICs). Compelling evidence from observational studies in high-income countries shows that trauma education programs, such as the Rural Trauma Team Development Course (RTTDC), increase clinician knowledge of injury care. There is a dearth of such evidence from controlled clinical trials to demonstrate the effect of the RTTDC on process and patient outcomes in LMICs. Objective: This multicenter cluster randomized controlled clinical trial aims to examine the impact of the RTTDC on process and patient outcomes associated with motorcycle accident--related injuries in an African low-resource setting. Methods: This is a 2-arm, parallel, multi-period, cluster randomized, controlled, clinical trial in Uganda, where rural trauma team development training is not routinely conducted. We will recruit regional referral hospitals and include patients with motorcycle accident--related injuries, interns, medical trainees, and road traffic law enforcement professionals. The intervention group (RTTDC) and control group (standard care) will include 3 hospitals each. The primary outcomes will be the interval from the accident to hospital admission and the interval from the referral decision to hospital discharge. The secondary outcomes will be all-cause mortality and morbidity associated with neurological and orthopedic injuries at 90 days after injury. All outcomes will be measured as final values. We will compare baseline characteristics and outcomes at both individual and cluster levels between the intervention and control groups. We will use mixed effects regression models to report any absolute or relative differences along with 95\% CIs. We will perform subgroup analyses to evaluate and control confounding due to injury mechanisms and injury severity. We will establish a motorcycle trauma outcome (MOTOR) registry in consultation with community traffic police. Results: The trial was approved on August 27, 2019. The actual recruitment of the first patient participant began on September 01, 2019. The last follow-up was on August 27, 2023. Posttrial care, including linkage to clinical, social support, and referral services, is to be completed by November 27, 2023. Data analyses will be performed in Spring 2024, and the results are expected to be published in Autumn 2024. Conclusions: This trial will unveil how a locally contextualized rural trauma team development program impacts organizational efficiency in a continent challenged with limited infrastructure and human resources. Moreover, this trial will uncover how rural trauma team coordination impacts clinical outcomes, such as mortality and morbidity associated with neurological and orthopedic injuries, which are the key targets for strengthening trauma systems in LMICs where prehospital care is in the early stage. Our results could inform the design, implementation, and scalability of future rural trauma teams and trauma education programs in LMICs. Trial Registration: Pan African Clinical Trials Registry (PACTR202308851460352); https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=25763 International Registered Report Identifier (IRRID): DERR1-10.2196/55297 ", doi="10.2196/55297", url="https://www.researchprotocols.org/2024/1/e55297", url="http://www.ncbi.nlm.nih.gov/pubmed/38713507" } @Article{info:doi/10.2196/40868, author="Burch, Vanessa and McGuire, Jessica and Buch, Eric and Sathekge, Mike and M'bouaffou, Francis and Senkubuge, Flavia and Fagan, Johannes", title="Feasibility and Acceptability of Web-Based Structured Oral Examinations for Postgraduate Certification: Mixed Methods Preliminary Evaluation", journal="JMIR Form Res", year="2024", month="Mar", day="6", volume="8", pages="e40868", keywords="web-based certification examinations", keywords="web-based structured oral examinations", keywords="medical education", keywords="specialist and subspecialist examinations", keywords="structured oral examinations", keywords="Colleges of Medicine of South Africa", abstract="Background: The COVID-19 pandemic disrupted postgraduate certification examinations globally. The Colleges of Medicine of South Africa continued hosting certification examinations through the pandemic. This was achieved by effecting a rapid transition from in-person to web-based certification examinations. Objective: This formative evaluation explored candidates' acceptability of web-based structured oral examinations (SOEs) hosted via Zoom (Zoom Communications Inc). We also reported the audiovisual quality and technical challenges encountered while using Zoom and candidates' overall experience with these examinations conducted during the early part of the COVID-19 pandemic. Additionally, performance in web-based certification examinations was compared with previous in-person certification examinations. Methods: This mixed methods, single-arm evaluation anonymously gathered candidates' perceptions of web-based SOE acceptability, audiovisual quality, and overall experience with Zoom using a web-based survey. Pass rates of web-based and previous in-person certification examinations were compared using chi-square tests, with a Yates correction. A thematic analysis approach was adopted for qualitative data. Results: Between June 2020 and June 2021, 3105 candidates registered for certification examinations, 293 (9.4\%) withdrew, 2812 (90.6\%) wrote, and 2799 (99.9\%) passed, and 1525 (54.2\%) were invited to a further web-based SOE. Examination participation was 96.2\% (n=1467). During the first web-based examination cycle (2020), 542 (87.1\%) of 622 web-based SOE candidates completed the web-based survey. They reported web-based SOEs as fair (374/542, 69\%) and adequately testing their clinical reasoning and insight (396/542, 73.1\%). Few would have preferred real patient encounters (173/542, 31.9\%) or in-person oral examinations (152/542, 28\%). Most found Zoom acceptable (434/542, 80\%) and fair (396/542, 73.1\%) for hosting web-based SOEs. SOEs resulted in financial (434/542, 80\%) and time (428/542, 79\%) savings for candidates. Many (336/542, 62\%) supported the ongoing use of web-based certification examinations. Only 169 technical challenges in using Zoom were reported, which included connectivity-related issues, poor audio quality, and poor image quality. The thematic analysis identified 4 themes of positive and negative experiences related to web-based SOE station design and content, examination station environment, examiner-candidate interactions, and personal benefits for candidates. Our qualitative analysis identified 10 improvements for future web-based SOEs. Candidates achieved high pass rates in web-based certification examinations in 2020 (1583/1732, 91.39\%) and 2021 (850/1067, 79.66\%). These were significantly higher (2020: N=8635; $\chi$21=667; P<.001; 2021: N=7988; $\chi$21=178; P<.001) than the previous in-person certification examination pass rate of 58.23\% (4030/6921; 2017-2019). Conclusions: Web-based SOEs conducted by the Colleges of Medicine of South Africa during the COVID-19 pandemic were well received by candidates, and few technical difficulties were encountered while using Zoom. Better performance was observed in web-based examinations than in previous in-person certification examinations. These early findings support the ongoing use of this assessment method. ", doi="10.2196/40868", url="https://formative.jmir.org/2024/1/e40868", url="http://www.ncbi.nlm.nih.gov/pubmed/38064633" } @Article{info:doi/10.2196/43699, author="Horst, Rebecca and Witsch, Lea-Mara and Hazunga, Rayford and Namuziya, Natasha and Syakantu, Gardner and Ahmed, Yusuf and Cherkaoui, Omar and Andreadis, Petros and Neuhann, Florian and Barteit, Sandra", title="Evaluating the Effectiveness of Interactive Virtual Patients for Medical Education in Zambia: Randomized Controlled Trial", journal="JMIR Med Educ", year="2023", month="Jun", day="29", volume="9", pages="e43699", keywords="global health", keywords="Zambia", keywords="health care workers", keywords="medical skills", keywords="e-logbook, digital global health", abstract="Background: Zambia is facing a severe shortage of health care workers, particularly in rural areas. Innovative educational programs and infrastructure have been established to bridge this gap; however, they encounter substantial challenges because of constraints in physical and human resources. In response to these shortcomings, strategies such as web-based and blended learning approaches have been implemented, using virtual patients (VPs) as a means to promote interactive learning at the Levy Mwanawasa Medical University (LMMU) in Zambia. Objective: This study aimed to evaluate the students' knowledge acquisition and acceptance of 2 VP medical topics as a learning tool on a Zambian higher education e-learning platform. Methods: Using a mixed methods design, we assessed knowledge acquisition using pre- and posttests. In a randomized controlled trial setting, students were assigned (1:1) to 2 medical topics (topic 1: appendicitis and topic 2: severe acute malnutrition) and then to 4 different learning tools within their respective exposure groups: VPs, textbook content, preselected e-learning materials, and self-guided internet materials. Acceptance was evaluated using a 15-item questionnaire with a 5-point Likert scale. Results: A total of 63 third- and fourth-year Bachelor of Science clinical science students participated in the study. In the severe acute malnutrition--focused group, participants demonstrated a significant increase in knowledge within the textbook group (P=.01) and the VP group (P=.01). No substantial knowledge gain was observed in the e-learning group or the self-guided internet group. For the appendicitis-focused group, no statistically significant difference in knowledge acquisition was detected among the 4 intervention groups (P=.62). The acceptance of learning materials exhibited no substantial difference between the VP medical topics and other learning materials. Conclusions: In the context of LMMU, our study found that VPs were well accepted and noninferior to traditional teaching methods. VPs have the potential to serve as an engaging learning resource and can be integrated into blended learning approaches at LMMU. However, further research is required to investigate the long-term knowledge gain and the acceptance and effectiveness of VPs in medical education. Trial Registration: Pan African Clinical Trials Registry (PACTR) PACTR202211594568574; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=20413 ", doi="10.2196/43699", url="https://mededu.jmir.org/2023/1/e43699", url="http://www.ncbi.nlm.nih.gov/pubmed/37384369" } @Article{info:doi/10.2196/37297, author="Ezenwa, Nkolika Beatrice and Umoren, Rachel and Fajolu, Bamikeolu Iretiola and Hippe, S. Daniel and Bucher, Sherri and Purkayastha, Saptarshi and Okwako, Felicitas and Esamai, Fabian and Feltner, B. John and Olawuyi, Olubukola and Mmboga, Annet and Nafula, Concepta Mary and Paton, Chris and Ezeaka, Chinyere Veronica", title="Using Mobile Virtual Reality Simulation to Prepare for In-Person Helping Babies Breathe Training: Secondary Analysis of a Randomized Controlled Trial (the eHBB/mHBS Trial)", journal="JMIR Med Educ", year="2022", month="Sep", day="12", volume="8", number="3", pages="e37297", keywords="virtual reality", keywords="mobile learning", keywords="Helping Babies Breathe", keywords="neonatal resuscitation", keywords="mobile Helping Babies Survive powered by District Health Information Software 2", keywords="neonatal mortality", keywords="digital education", keywords="health care education", keywords="health care worker", keywords="medical education", keywords="digital intervention", abstract="Background: Neonatal mortality accounts for approximately 46\% of global under-5 child mortality. The widespread access to mobile devices in low- and middle-income countries has enabled innovations, such as mobile virtual reality (VR), to be leveraged in simulation education for health care workers. Objective: This study explores the feasibility and educational efficacy of using mobile VR for the precourse preparation of health care professionals in neonatal resuscitation training. Methods: Health care professionals in obstetrics and newborn care units at 20 secondary and tertiary health care facilities in Lagos, Nigeria, and Busia, Western Kenya, who had not received training in Helping Babies Breathe (HBB) within the past 1 year were randomized to access the electronic HBB VR simulation and digitized HBB Provider's Guide (VR group) or the digitized HBB Provider's Guide only (control group). A sample size of 91 participants per group was calculated based on the main study protocol that was previously published. Participants were directed to use the electronic HBB VR simulation and digitized HBB Provider's Guide or the digitized HBB Provider's Guide alone for a minimum of 20 minutes. HBB knowledge and skills assessments were then conducted, which were immediately followed by a standard, in-person HBB training course that was led by study staff and used standard HBB evaluation tools and the Neonatalie Live manikin (Laerdal Medical). Results: A total of 179 nurses and midwives participated (VR group: n=91; control group: n=88). The overall performance scores on the knowledge check (P=.29), bag and mask ventilation skills check (P=.34), and Objective Structured Clinical Examination A checklist (P=.43) were similar between groups, with low overall pass rates (6/178, 3.4\% of participants). During the Objective Structured Clinical Examination A test, participants in the VR group performed better on the critical step of positioning the head and clearing the airway (VR group: 77/90, 86\%; control group: 57/88, 65\%; P=.002). The median percentage of ventilations that were performed via head tilt, as recorded by the Neonatalie Live manikin, was also numerically higher in the VR group (75\%, IQR 9\%-98\%) than in the control group (62\%, IQR 13\%-97\%), though not statistically significantly different (P=.35). Participants in the control group performed better on the identifying a helper and reviewing the emergency plan step (VR group: 7/90, 8\%; control group: 16/88, 18\%; P=.045) and the washing hands step (VR group: 20/90, 22\%; control group: 32/88, 36\%; P=.048). Conclusions: The use of digital interventions, such as mobile VR simulations, may be a viable approach to precourse preparation in neonatal resuscitation training for health care professionals in low- and middle-income countries. ", doi="10.2196/37297", url="https://mededu.jmir.org/2022/3/e37297", url="http://www.ncbi.nlm.nih.gov/pubmed/36094807" } @Article{info:doi/10.2196/32614, author="Guillaume, Dominique and Troncoso, Erica and Duroseau, Brenice and Bluestone, Julia and Fullerton, Judith", title="Mobile-Social Learning for Continuing Professional Development in Low- and Middle-Income Countries: Integrative Review", journal="JMIR Med Educ", year="2022", month="Jun", day="7", volume="8", number="2", pages="e32614", keywords="digital learning", keywords="continuing medical education", keywords="mHealth", keywords="peer learning", keywords="mentorship", keywords="health systems", keywords="global health", keywords="mobile phone", abstract="Background: Access to continuing professional development (CPD) for health care workers in low- and middle-income countries (LMICs) is severely limited. Digital technology serves as a promising platform for supporting CPD for health care workers by providing educational content virtually and enabling virtual peer-to-peer and mentor interaction for enhanced learning. Digital strategies for CPD that foster virtual interaction can increase workforce retention and bolster the health workforce in LMICs. Objective: The objective of this integrative review was to evaluate the evidence on which digital platforms were used to provide CPD to health care workers and clinical students in LMICs, which was complemented with virtual peer-to-peer or mentor interaction. We phrased this intersection of virtual learning and virtual interaction as mobile-social learning. Methods: A comprehensive database and gray literature search was conducted to identify qualitative, quantitative, and mixed methods studies, along with empirical evidence, that used digital technology to provide CPD and virtual interaction with peers or mentors. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Eligible articles were written in English, conducted in an LMIC, and used a mobile device to provide CPD and facilitate virtual peer-to-peer or mentor interaction. Titles, abstracts, and full texts were screened, followed by an assessment of the quality of evidence and an appraisal of the articles. A content analysis was then used to deductively code the data into emerging themes. Results: A total of 750 articles were identified, and 31 (4.1\%) were included in the review. SMS text messaging and mobile instant messaging were the most common methods used to provide continuing education and virtual interaction between peers and mentors (25/31, 81\%). Across the included articles, participants had high acceptability for using digital platforms for learning and interaction. Virtual peer interaction and mentorship were found to contribute to positive learning outcomes in most studies (27/31, 87\%) through increased knowledge sharing, knowledge gains, improved clinical skills, and improved service delivery. Peer-to-peer and mentor interaction were found to improve social support and reduce feelings of isolation (9/31, 29\%). There were several challenges in the implementation and use of digital technology for mobile-social learning, including limited access to resources (eg, internet coverage and stable electricity), flexibility in scheduling to participate in CPD, and sociobehavioral challenges among students. Conclusions: The summary suggests that mobile-social learning is a useful modality for curriculum dissemination and skill training and that the interface of mobile and social learning serves as a catalyst for improved learning outcomes coupled with increased social capital. ", doi="10.2196/32614", url="https://mededu.jmir.org/2022/2/e32614", url="http://www.ncbi.nlm.nih.gov/pubmed/35671080" } @Article{info:doi/10.2196/28965, author="Tilahun, Binyam and Endehabtu, F. Berhanu and Gashu, D. Kassahun and Mekonnen, A. Zeleke and Animut, Netsanet and Belay, Hiwot and Denboba, Wubshet and Alemu, Hibret and Mohammed, Mesoud and Abate, Biruk", title="Current and Future Needs for Human Resources for Ethiopia's National Health Information System: Survey and Forecasting Study", journal="JMIR Med Educ", year="2022", month="Apr", day="12", volume="8", number="2", pages="e28965", keywords="forecasting", keywords="human resources", keywords="health information system", keywords="workforce", keywords="Ethiopia", keywords="health informatics", keywords="healthcare professionals", abstract="Background: Strengthening the national health information system is one of Ethiopia's priority transformation agendas. A well-trained and competent workforce is the essential ingredient to a strong health information system. However, this workforce has neither been quantified nor characterized well, and there is no roadmap of required human resources to enhance the national health information system. Objective: We aimed to determine the current state of the health information system workforce and to forecast the human resources needed for the health information system by 2030. Methods: We conducted a survey to estimate the current number of individuals employed in the health information system unit and the turnover rate. Document review and key-informant interviews were used to collect current human resources and available health information system position data from 110 institutions, including the Ministry of Health, federal agencies, regional health bureaus, zonal health departments, district health offices, and health facilities. The Delphi technique was used to forecast human resources required for the health information system in the next ten years: 3 rounds of workshops with experts from the Ministry of Health, universities, agencies, and regional health bureaus were held. In the first expert meeting, we set criteria, which was followed by expert suggestions and feedback. Results: As of April 2020, there were 10,344 health information system professionals working in the governmental health system. Nearly 95\% (20/21) of district health offices and 86.7\% (26/30) of health centers reported that the current number of health information system positions was inadequate. In the period from June 2015 to June 2019, health information technicians had high turnover (48/244, 19.7\%) at all levels of the health system. In the next ten years, we estimate that 50,656 health information system professionals will be needed to effectively implement the Ethiopia's national health information system. Conclusions: Current health information system--related staffing levels were found to be inadequate. To meet the estimated need of 50,656 multidisciplinary health information system professionals by 2030, the Ministry of Health and regional health bureaus, in collaboration with partners and academic institutions, need to work on retaining existing and training additional health information system professionals. ", doi="10.2196/28965", url="https://mededu.jmir.org/2022/2/e28965", url="http://www.ncbi.nlm.nih.gov/pubmed/35412469" } @Article{info:doi/10.2196/34751, author="Schnieders, Elena and R{\"o}hr, Freda and Mbewe, Misho and Shanzi, Aubrey and Berner-Rodoreda, Astrid and Barteit, Sandra and Louis, R. Val{\'e}rie and Andreadis, Petros and Syakantu, Gardner and Neuhann, Florian", title="Real-life Evaluation of an Interactive Versus Noninteractive e-Learning Module on Chronic Obstructive Pulmonary Disease for Medical Licentiate Students in Zambia: Web-Based, Mixed Methods Randomized Controlled Trial", journal="JMIR Med Educ", year="2022", month="Feb", day="24", volume="8", number="1", pages="e34751", keywords="distance education", keywords="randomized controlled trial", keywords="personal satisfaction", keywords="knowledge", keywords="user-centered design", keywords="chronic obstructive pulmonary disease", keywords="interactive", keywords="noninteractive", keywords="low- and middle-income country", keywords="LMIC", keywords="mobile phone", abstract="Background: e-Learning for health professionals in many low- and middle-income countries (LMICs) is still in its infancy, but with the advent of COVID-19, a significant expansion of digital learning has occurred. Asynchronous e-learning can be grouped into interactive (user-influenceable content) and noninteractive (static material) e-learning. Studies conducted in high-income countries suggest that interactive e-learning is more effective than noninteractive e-learning in increasing learner satisfaction and knowledge; however, there is a gap in our understanding of whether this also holds true in LMICs. Objective: This study aims to validate the hypothesis above in a resource-constrained and real-life setting to understand e-learning quality and delivery by comparing interactive and noninteractive e-learning user satisfaction, usability, and knowledge gain in a new medical university in Zambia. Methods: We conducted a web-based, mixed methods randomized controlled trial at the Levy Mwanawasa Medical University (LMMU) in Lusaka, Zambia, between April and July 2021. We recruited medical licentiate students (second, third, and fourth study years) via email. Participants were randomized to undergo asynchronous e-learning with an interactive or noninteractive module for chronic obstructive pulmonary disease and informally blinded to their group allocation. The interactive module included interactive interfaces, quizzes, and a virtual patient, whereas the noninteractive module consisted of PowerPoint slides. Both modules covered the same content scope. The primary outcome was learner satisfaction. The secondary outcomes were usability, short- and long-term knowledge gain, and barriers to e-learning. The mixed methods study followed an explanatory sequential design in which rating conferences delivered further insights into quantitative findings, which were evaluated through web-based questionnaires. Results: Initially, 94 participants were enrolled in the study, of whom 41 (44\%; 18 intervention participants and 23 control participants) remained in the study and were analyzed. There were no significant differences in satisfaction (intervention: median 33.5, first quartile 31.3, second quartile 35; control: median 33, first quartile 30, second quartile 37.5; P=.66), usability, or knowledge gain between the intervention and control groups. Challenges in accessing both e-learning modules led to many dropouts. Qualitative data suggested that the content of the interactive module was more challenging to access because of technical difficulties and individual factors (eg, limited experience with interactive e-learning). Conclusions: We did not observe an increase in user satisfaction with interactive e-learning. However, this finding may not be generalizable to other low-resource settings because the post hoc power was low, and the e-learning system at LMMU has not yet reached its full potential. Consequently, technical and individual barriers to accessing e-learning may have affected the results, mainly because the interactive module was considered more difficult to access and use. Nevertheless, qualitative data showed high motivation and interest in e-learning. Future studies should minimize technical barriers to e-learning to further evaluate interactive e-learning in LMICs. ", doi="10.2196/34751", url="https://mededu.jmir.org/2022/1/e34751", url="http://www.ncbi.nlm.nih.gov/pubmed/35200149" } @Article{info:doi/10.2196/22096, author="Samarasekara, Keshinie", title="e-Learning in Medical Education in Sri Lanka: Survey of Medical Undergraduates and New Graduates", journal="JMIR Med Educ", year="2022", month="Feb", day="10", volume="8", number="1", pages="e22096", keywords="medical education", keywords="e-learning", keywords="Sri Lanka", keywords="medical students", abstract="Background: Medical education has undergone drastic changes with the advent of novel technologies that enable e-learning. Medical students are increasingly using e-learning methods, and universities have incorporated them into their curricula. Objective: This study aimed at delineating the pattern of use of e-learning methods among medical undergraduates and new graduates of the Faculty of Medicine, University of Colombo, and identifying the challenges faced by these students in using e-learning methods. Methods: A cross-sectional descriptive study was conducted in the Faculty of Medicine, University of Colombo, in April 2020, with the participation of current undergraduates and pre-intern medical graduates, using a self-administered questionnaire that collected data on sociodemographic details, pattern of use of learning methods, and challenges faced using e-learning methods. Results: There were 778 respondents, with a response rate of 65.1\% (778/1195). All the study participants used e-learning resources with varying frequencies, and all of them had at least 1 smart device with access to the internet. Electronic versions of standard textbooks (e-books), nonmedical websites, online lectures, medical websites, and medical phone apps were used by the majority. When comparing the extent of use of different learning methods, it appeared that students preferentially used traditional learning methods. The preference was influenced by the year of study and family income. The 3 most commonly used modalities for learning new study material and revising previously learned content were notes on paper material, textbooks (paper version), and e-books. The majority (98.7\% [n=768]) of participants have encountered problems using e-learning resources. The most commonly faced problems were unavailability of free-of-charge access to some e-learning methods, expenses related to internet connection, poor connectivity of mobile internet, distractions while using online resources, and lack of storage space on electronic devices. Conclusions: There is a high uptake of e-learning methods among Sri Lankan medical students. However, when comparing the extent of use of different learning methods, it appeared that students preferentially used traditional learning methods. A majority of the students have encountered problems when using e-learning methods, and most of these problems were related to poor economic status. Universities should take these factors into consideration when developing curricula in medical education. ", doi="10.2196/22096", url="https://mededu.jmir.org/2022/1/e22096", url="http://www.ncbi.nlm.nih.gov/pubmed/35142626" } @Article{info:doi/10.2196/30755, author="John, Oommen and Sarbadhikari, Nath Suptendra and Prabhu, Thanga and Goel, Ashvini and Thomas, Alexander and Shroff, Sunil and Allaudin, Fazilah and Weerabaddana, Chaminda and Alhuwail, Dari and Koirala, Udaya and Johnrose, Jayalal and Codyre, Patricia and Bleaden, Andy and Singh, Shubnum and Bajaj, Shuchin", title="Implementation and Experiences of Telehealth: Balancing Policies With Practice in Countries of South Asia, Kuwait, and the European Union", journal="Interact J Med Res", year="2022", month="Feb", day="8", volume="11", number="1", pages="e30755", keywords="telehealth policy and practice", keywords="implementation lessons", keywords="challenges in scaling up", keywords="capacity building of human resources", keywords="data privacy", keywords="telehealth", keywords="health policy", keywords="telemedicine", keywords="implementation", keywords="challenges", keywords="human resources", keywords="digital health", keywords="data security", doi="10.2196/30755", url="https://www.i-jmr.org/2022/1/e30755", url="http://www.ncbi.nlm.nih.gov/pubmed/35133279" } @Article{info:doi/10.2196/28644, author="Zombre, David and Kortenaar, Jean-Luc and Zareef, Farhana and Doumbia, Moussa and Doumbia, Sekou and Haidara, Fadima and McLaughlin, Katie and Sow, Samba and Bhutta, A. Zulfiqar and Bassani, G. Diego", title="Combined Clinical Audits and Low-Dose, High-frequency, In-service Training of Health Care Providers and Community Health Workers to Improve Maternal and Newborn Health in Mali: Protocol for a Pragmatic Cluster Randomized Trial", journal="JMIR Res Protoc", year="2021", month="Dec", day="10", volume="10", number="12", pages="e28644", keywords="perinatal mortality", keywords="low dose high frequency training", keywords="maternal and newborn health outcomes", keywords="Mali", abstract="Background: Although most births in Mali occur in health facilities, a substantial number of newborns still die during delivery and within the first 7 days of life, mainly because of existing training deficiencies and the challenges of maintaining intrapartum and postpartum care skills. Objective: This trial aims to assess the effectiveness and cost-effectiveness of an intervention combining clinical audits and low-dose, high-frequency (LDHF) in-service training of health care providers and community health workers to reduce perinatal mortality. Methods: The study is a three-arm cluster randomized controlled trial in the Koulikoro region in Mali. The units of randomization are each of 84 primary care facilities. Each trial arm will include 28 facilities. The facilities in the first intervention arm will receive support in implementing mortality and morbidity audits, followed by one-day LDHF training biweekly, for 6 months. The health workers in the second intervention arm (28 facilities) will receive a refresher course in maternal neonatal and child health (MNCH) for 10 days in a classroom setting, in addition to mortality and morbidity audits and LDHF hands-on training for 6 months. The control arm, also with 28 facilities, will consist solely of the standard MNCH refresher training delivered in a classroom setting. The main outcomes are perinatal deaths in the intervention arms compared with those in the control arm. A final sample of approximately 600 deliveries per cluster was expected for a total of 30,000 newborns over 14 months. Data sources included both routine health records and follow-up household surveys of all women who recently gave birth in the study facility 7 days postdelivery. Data collection tools will capture perinatal deaths, complications, and adverse events, as well as the status of the newborn during the perinatal period. A full economic evaluation will be conducted to determine the incremental cost-effectiveness of each of the case-based focused LDHF hands-on training strategies in comparison to MNCH refresher training in a classroom setting. Results: The trial is complete. The recruitment began on July 15, 2019, and data collection began on July 23, 2019, and was completed in November 2020. Data cleaning or analyses began at the time of submission of the protocol. Conclusions: The results will provide policy makers and practitioners with crucial information on the impact of different health care provider training modalities on maternal and newborn health outcomes and how to successfully implement these strategies in resource-limited settings. Trial Registration: ClinicalTrials.gov NCT03656237; https://clinicaltrials.gov/ct2/show/NCT03656237 International Registered Report Identifier (IRRID): DERR1-10.2196/28644 ", doi="10.2196/28644", url="https://www.researchprotocols.org/2021/12/e28644", url="http://www.ncbi.nlm.nih.gov/pubmed/34889776" } @Article{info:doi/10.2196/24182, author="Hicks, Paul Joseph and Allsop, John Matthew and Akaba, O. Godwin and Yalma, M. Ramsey and Dirisu, Osasuyi and Okusanya, Babasola and Tukur, Jamilu and Okunade, Kehinde and Akeju, David and Ajepe, Adegbenga and Okuzu, Okey and Mirzoev, Tolib and Ebenso, Bassey", title="Acceptability and Potential Effectiveness of eHealth Tools for Training Primary Health Workers From Nigeria at Scale: Mixed Methods, Uncontrolled Before-and-After Study", journal="JMIR Mhealth Uhealth", year="2021", month="Sep", day="16", volume="9", number="9", pages="e24182", keywords="primary health worker training", keywords="digital health technology", keywords="eHealth", keywords="video-based training", keywords="maternal and child health", keywords="Nigeria", keywords="mobile phone", abstract="Background: The in-service training of frontline health workers (FHWs) in primary health care facilities plays an important role in improving the standard of health care delivery. However, it is often expensive and requires FHWs to leave their posts in rural areas to attend courses in urban centers. This study reports the implementation of a digital health tool for providing video training (VTR) on maternal, newborn, and child health (MNCH) care to provide in-service training at scale without interrupting health services. The VTR intervention was supported by satellite communications technology and existing 3G mobile networks. Objective: This study aims to determine the feasibility and acceptability of these digital health tools and their potential effectiveness in improving clinical knowledge, attitudes, and practices related to MNCH care. Methods: A mixed methods design, including an uncontrolled pre- and postquantitative evaluation, was adopted. From October 2017 to May 2018, a VTR mobile intervention was delivered to FHWs in 3 states of Nigeria. We examined changes in workers' knowledge and confidence in delivering MNCH services through a pre- and posttest survey. Stakeholders' experiences with the intervention were explored through semistructured interviews that drew on the technology acceptance model to frame contextual factors that shaped the intervention's acceptability and usability in the work environment. Results: In total, 328 FHWs completed both pre- and posttests. FHWs achieved a mean pretest score of 51\% (95\% CI 48\%-54\%) and mean posttest score of 69\% (95\% CI 66\%-72\%), reflecting, after adjusting for key covariates, a mean increase between the pre- and posttest of 17 percentage points (95\% CI 15-19; P<.001). Variation was identified in pre- and posttest scores by the sex and location of participants alongside topic-specific areas where scores were lowest. Stakeholder interviews suggested a 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 found that VTR 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 determinants of technology acceptance included ease of use, perceived usefulness, access to technology and training contents, and the cost-effectiveness of VTR, whereas barriers to the adoption of VTR were poor electricity supply, poor internet connection, and FHWs' workload. The evaluation also identified the mechanisms of the impact of delivering VTR Mobile at scale on the micro (individual), meso (organizational), and macro (policy) levels of the health system. Future research is required to explore the translation of this digital health approach for the VTR of FHWs and its impact across low-resource settings to ameliorate the financial and time costs of training and support high-quality MNCH care delivery. Trial Registration: ISRCTN Registry 32105372; https://www.isrctn.com/ISRCTN32105372 ", doi="10.2196/24182", url="https://mhealth.jmir.org/2021/9/e24182", url="http://www.ncbi.nlm.nih.gov/pubmed/34528891" } @Article{info:doi/10.2196/28905, author="Kagawa, Nantamu Mike and Chipamaunga, Shalote and Prozesky, Detlef and Kafumukache, Elliot and Gwini, Rudo and Kandawasvika, Gwendoline and Katowa-Mukwato, Patricia and Masanganise, Rangarirai and Pretorius, Louise and Wessels, Quenton and Dithole, S. Kefalotse and Marimo, Clemence and Mubuuke, Gonzaga Aloysius and Mbalinda, Nalugo Scovia and van der Merwe, Lynette and Nyoni, N. Champion", title="Assessment of Preparedness for Remote Teaching and Learning to Transform Health Professions Education in Sub-Saharan Africa in Response to the COVID-19 Pandemic: Protocol for a Mixed Methods Study With a Case Study Approach", journal="JMIR Res Protoc", year="2021", month="Jul", day="28", volume="10", number="7", pages="e28905", keywords="Africa", keywords="COVID-19", keywords="emergency remote teaching", keywords="formal online learning", keywords="pandemic", abstract="Background: The current COVID-19 pandemic is affecting all aspects of society worldwide. To combat the pandemic, measures such as face mask--wearing, hand-washing and -sanitizing, movement restrictions, and social distancing have been introduced. These measures have significantly disrupted education, particularly health professions education, which depends on student-patient contact for the development of clinical competence. The wide-ranging consequences of the pandemic are immense, and health professions education institutions in sub-Saharan Africa have not been spared. Objective: This paper describes a protocol for assessing the preparedness of selected health professions education institutions in sub-Saharan Africa for remote teaching and learning during the COVID-19 pandemic. Methods: A mixed-methods design with a case study approach will be used. The awareness, desire, knowledge, ability, and reinforcement model of change was selected as the conceptual framework to guide the study. Eight higher education institutions in 6 sub-Saharan countries have participated in this study. Data will be collected through electronic surveys from among whole populations of academic staff, students, and administrators in undergraduate medicine and nursing programs. Qualitative and quantitative data from each institution will be analyzed as a case study, which will yield an inventory of similar cases grouped for comparison. Quantitative data will be analyzed for each institution and then compared to determine associations among variables and differences among programs, institutions, or countries. Results: Our findings will provide information to higher education institutions, particularly those offering health professions education programs, in Africa regarding the preparedness for remote teaching and learning to influence efforts related to web-based teaching and learning, which is envisaged to become the new normal in the future. Conclusions: This study has not received any funding, and any costs involved were borne by individual consortium members at the various institutions. Ethics approval from the institutional review board was obtained at various times across the participating sites, which were free to commence data collection as soon as approval was obtained. Data collection was scheduled to begin on October 1, 2020, and end on February 28, 2021. As of this submission, data collection has been completed, and a total of 1099 participants have been enrolled. Data analysis has not yet commenced. International Registered Report Identifier (IRRID): DERR1-10.2196/28905 ", doi="10.2196/28905", url="https://www.researchprotocols.org/2021/7/e28905", url="http://www.ncbi.nlm.nih.gov/pubmed/34254943" } @Article{info:doi/10.2196/29080, author="Barteit, Sandra and Lanfermann, Lucia and B{\"a}rnighausen, Till and Neuhann, Florian and Beiersmann, Claudia", title="Augmented, Mixed, and Virtual Reality-Based Head-Mounted Devices for Medical Education: Systematic Review", journal="JMIR Serious Games", year="2021", month="Jul", day="8", volume="9", number="3", pages="e29080", keywords="virtual reality", keywords="augmented reality", keywords="global health", keywords="income-limited countries", keywords="medical education", abstract="Background: Augmented reality (AR), mixed reality (MR), and virtual reality (VR), realized as head-mounted devices (HMDs), may open up new ways of teaching medical content for low-resource settings. The advantages are that HMDs enable repeated practice without adverse effects on the patient in various medical disciplines; may introduce new ways to learn complex medical content; and may alleviate financial, ethical, and supervisory constraints on the use of traditional medical learning materials, like cadavers and other skills lab equipment. Objective: We examine the effectiveness of AR, MR, and VR HMDs for medical education, whereby we aim to incorporate a global health perspective comprising low- and middle-income countries (LMICs). Methods: We conducted a systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) and Cochrane guidelines. Seven medical databases (PubMed, Cochrane Library, Web of Science, Science Direct, PsycINFO, Education Resources Information Centre, and Google Scholar) were searched for peer-reviewed publications from January 1, 2014, to May 31, 2019. An extensive search was carried out to examine relevant literature guided by three concepts of extended reality (XR), which comprises the concepts of AR, MR, and VR, and the concepts of medicine and education. It included health professionals who took part in an HMD intervention that was compared to another teaching or learning method and evaluated with regard to its effectiveness. Quality and risk of bias were assessed with the Medical Education Research Study Quality Instrument, the Newcastle-Ottawa Scale-Education, and A Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies of Interventions. We extracted relevant data and aggregated the data according to the main outcomes of this review (knowledge, skills, and XR HMD). Results: A total of 27 studies comprising 956 study participants were included. The participants included all types of health care professionals, especially medical students (n=573, 59.9\%) and residents (n=289, 30.2\%). AR and VR implemented with HMDs were most often used for training in the fields of surgery (n=13, 48\%) and anatomy (n=4, 15\%). A range of study designs were used, and quantitative methods were clearly dominant (n=21, 78\%). Training with AR- and VR-based HMDs was perceived as salient, motivating, and engaging. In the majority of studies (n=17, 63\%), HMD-based interventions were found to be effective. A small number of included studies (n=4, 15\%) indicated that HMDs were effective for certain aspects of medical skills and knowledge learning and training, while other studies suggested that HMDs were only viable as an additional teaching tool (n=4, 15\%). Only 2 (7\%) studies found no effectiveness in the use of HMDs. Conclusions: The majority of included studies suggested that XR-based HMDs have beneficial effects for medical education, whereby only a minority of studies were from LMICs. Nevertheless, as most studies showed at least noninferior results when compared to conventional teaching and training, the results of this review suggest applicability and potential effectiveness in LMICs. Overall, users demonstrated greater enthusiasm and enjoyment in learning with XR-based HMDs. It has to be noted that many HMD-based interventions were small-scale and conducted as short-term pilots. To generate relevant evidence in the future, it is key to rigorously evaluate XR-based HMDs with AR and VR implementations, particularly in LMICs, to better understand the strengths and shortcomings of HMDs for medical education. ", doi="10.2196/29080", url="https://games.jmir.org/2021/3/e29080", url="http://www.ncbi.nlm.nih.gov/pubmed/34255668" } @Article{info:doi/10.2196/18935, author="Olaniyi, Adebola Adenike and Ncama, Purity Busisiwe and Amod, Hafaza", title="Mapping Evidence of Neonatal Resuscitation Training on the Practices of Unskilled Birth Attendants in Low-Resource Countries: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2021", month="Mar", day="31", volume="10", number="3", pages="e18935", keywords="neonatal resuscitation", keywords="newborn", keywords="neonatal", keywords="low- and middle-resource countries", keywords="training", keywords="birth", keywords="infant", keywords="baby", keywords="obstetrics", keywords="protocol", keywords="review", abstract="Background: Competence in neonatal resuscitation of the newborn is very critical to ensure the safety and well-being of newborn infants. The acquisition of neonatal resuscitation skills by birth attendants improves self-efficacy, thereby reducing neonatal mortality as a result of asphyxia. Approximately one-quarter of all neonatal deaths globally are caused by birth asphyxia. The need for neonatal resuscitation is most imperative in resource-constrained settings, where access to intrapartum obstetric care is inadequate. Objective: This protocol describes the methodology of a scoping review on evidence of training in neonatal resuscitation and its association with practice in low-resource countries. The aim of the review is to map the available evidence of neonatal resuscitation training on the practices of unskilled birth attendants. Methods: The scoping review will use the Population, Concept, and Context (PCC) framework proposed by Arksey and O'Malley, refined by Levac et al, and published by Joanna Briggs Institute, while following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The search strategy was developed with the assistance of the college librarian. A number of databases of peer-reviewed research (PsycINFO and Wiley Online Library [via EBSCOhost], PubMed, MEDLINE with full text, Google Scholar [via ScienceDirect], and CINAHL Plus with full text [via EBSCOhost]) and databases committed to grey literature sources will be searched, and reference extraction will be performed. Two independent reviewers will screen and extract data, and discrepancies will be resolved by a third reviewer. The extracted data will undergo a descriptive analysis of contextual data and a quantitative analysis using appropriate statistical methods. Results: Data relating to neonatal resuscitation training and practices in low-resource settings will be extracted and included for analysis. We expect that the review will be completed 12 months from the publication of this protocol. Conclusions: This scoping review will focus on the review of evidence and provide an insight into the existing literature to guide further research and identify implementation strategies to improve the practices of unskilled birth attendants through the acquisition of skills and self-efficacy in neonatal resuscitation. The results of this review will be presented at relevant conferences related to newborn and child health and neonatal nursing studies and published in a peer-reviewed journal. International Registered Report Identifier (IRRID): DERR1-10.2196/18935 ", doi="10.2196/18935", url="https://www.researchprotocols.org/2021/3/e18935", url="http://www.ncbi.nlm.nih.gov/pubmed/33787506" } @Article{info:doi/10.2196/17765, author="Isangula, Kahabi and Edwards, Grace and Mwansisya, Tumbwene and Mbekenga, Columba and Pallangyo, Eunice and Sarki, Ahmed and Ndirangu-Mugo, Eunice", title="Open and Distance Learning Programs for Nursing and Midwifery Education in East Africa: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2021", month="Jan", day="11", volume="10", number="1", pages="e17765", keywords="open and distance", keywords="learning", keywords="health care", keywords="nurses", keywords="midwifery", keywords="health", keywords="East Africa", abstract="Background: In the face of growing modernity and the coronavirus disease 2019 (COVID-19) pandemic, open and distance learning (ODL) is considered to play an important role in increasing access to education worldwide. There is a robust evidence base demonstrating its cost effectiveness in comparison with conventional class-based teaching; however, the transition to this new paradigm of learning for nursing and midwifery courses has been difficult in low-income countries. While there are notable efforts to increase internet and education access to health care professionals, not much is known about ODL for nurses and midwives in East African countries. Objective: The objective of this scoping review is to understand whether ODL programs for nursing and midwifery education exist, the drivers of their adoption, their implementation, the topics/courses covered, their acceptability, and their impacts in East African countries. Methods: The scoping review methodology employs the framework developed by Arksey and O'Malley. Using an exploratory approach, a two-stage screening process consisting of a title and abstract scan and a full-text review will be used to determine the eligibility of articles. To be included, articles must report on an existing ODL initiative for nurses and midwives in Uganda, Tanzania, and Kenya. All articles will be independently assessed for eligibility by pairs of reviewers, and all eligible articles will be abstracted and charted in duplicate using a standardized form. Results: Details of ODL for nursing and midwifery education initiatives and study outcomes will be summarized in a table. The extracted data will undergo exploratory descriptive analysis, and the results will be classified into learner and clinical outcomes. Conclusions: Evidence on ODL for nursing and midwifery education will inform the ongoing development and restructuring of health care professional education in East Africa amidst the COVID-19 pandemic. International Registered Report Identifier (IRRID): PRR1-10.2196/17765 ", doi="10.2196/17765", url="http://www.researchprotocols.org/2021/1/e17765/", url="http://www.ncbi.nlm.nih.gov/pubmed/33427679" } @Article{info:doi/10.2196/16946, author="Kynge, Lucy", title="Finding the Best Way to Deliver Online Educational Content in Low-Resource Settings: Qualitative Survey Study", journal="JMIR Med Educ", year="2020", month="May", day="26", volume="6", number="1", pages="e16946", keywords="online education", keywords="digital content", keywords="health care", keywords="burns", keywords="low-resource settings", abstract="Background: The reach of internet and mobile phone coverage has grown rapidly in low- and middle-income countries (LMICs). The potential for sharing knowledge with health care workers in low-resource settings to improve working practice is real, but barriers exist that limit access to online information. Burns affect more than 11 million people each year, but health care workers in low-resource settings receive little or no training in treating burn patients. Interburns' training programs are tailor-made to improve the quality of burn care in Asia, Africa, and the Middle East; the challenge is to understand the best way of delivering these resources digitally toward improved treatment and care of burn patients. Objective: The aim of the study, funded by the National Institute for Health Research (NIHR), was to understand issues and barriers that affect health care worker access to online learning in low-resource settings in order to broaden access to Interburns' training materials and improve burn-patient care. Methods: A total of 546 participants of Interburns' Essential Burn Care (EBC) course held in Bangladesh, Nepal, Ethiopia, and the West Bank, the occupied Palestinian Territories, between January 2016 and June 2018 were sent an online survey. EBC participants represent the wide range of health care professionals involved with the burn-injured patient. A literature review was carried out as well as research into online platforms. Results: A total of 207 of 546 (37.9\%) participants of the EBC course did not provide an email address. Of the 339 email addresses provided, 81 (23.9\%) ``bounced'' back. Surgeons and doctors were more likely to provide an email address than nurses, intern doctors, or auxiliary health care workers. A total of 258 participants received the survey and 70 responded, giving a response rate of 27.1\%. Poor internet connection, lack of time, and limited access to computers were the main reasons for not engaging with online learning, along with lack of relevant materials. Computers were seen as more useful for holding information, while mobile phones were better for communicating and sharing knowledge. Health care workers in LMICs use mobile phones professionally on a daily basis. A total of 80\% (56/70) felt that educational content on burns should be available through mobile apps. Conclusions: Health care workers in low-resource settings face a variety of barriers to accessing educational content online. The reliance on email for sign-up to learning management systems is a significant barrier. Materials need to be relevant, localized, and easy to consume offline if necessary, to avoid costs of mobile phone data. Smartphones are increasingly used professionally every day for communication and searching for information, pointing toward the need for tailored educational content to be more available through mobile- and web-based apps. ", doi="10.2196/16946", url="http://mededu.jmir.org/2020/1/e16946/", url="http://www.ncbi.nlm.nih.gov/pubmed/32452810" } @Article{info:doi/10.2196/12128, author="Adam, Maya and McMahon, A. Shannon and Prober, Charles and B{\"a}rnighausen, Till", title="Human-Centered Design of Video-Based Health Education: An Iterative, Collaborative, Community-Based Approach", journal="J Med Internet Res", year="2019", month="Jan", day="30", volume="21", number="1", pages="e12128", keywords="human-centered design", keywords="health promotion", keywords="health behavior", keywords="health knowledge, attitudes, practice", keywords="community health workers", keywords="telemedicine", keywords="eHealth", keywords="mHealth", doi="10.2196/12128", url="http://www.jmir.org/2019/1/e12128/", url="http://www.ncbi.nlm.nih.gov/pubmed/30698531" } @Article{info:doi/10.2196/12637, author="Barteit, Sandra and Neuhann, Florian and B{\"a}rnighausen, Till and Bowa, Annel and L{\"u}ders, Sigrid and Malunga, Gregory and Chileshe, Geoffrey and Marimo, Clemence and Jahn, Albrecht", title="Perspectives of Nonphysician Clinical Students and Medical Lecturers on Tablet-Based Health Care Practice Support for Medical Education in Zambia, Africa: Qualitative Study", journal="JMIR Mhealth Uhealth", year="2019", month="Jan", day="15", volume="7", number="1", pages="e12637", keywords="educational technology", keywords="computers, handheld", keywords="computer-assisted decision making", keywords="mobile apps", keywords="information dissemination", keywords="education", keywords="allied health occupations", keywords="Africa, Southern", keywords="Zambia", abstract="Background: Zambia is faced with a severe shortage of health workers and challenges in national health financing. This burdens the medical licentiate practitioner (MLP) program for training nonphysician clinical students in Zambia because of the shortage of qualified medical lecturers and learning resources at training sites. To address this shortage and strengthen the MLP program, a self-directed electronic health (eHealth) platform was introduced, comprising technology-supported learning (e-learning) for medical education and support for health care practice. MLP students were provided with tablets that were preloaded with content for offline access. Objective: This study aimed to explore MLP students' and medical lecturers' perceptions of the self-directed eHealth platform with an offline-based tablet as a training and health care practice support tool during the first year of full implementation. Methods: We conducted in-depth qualitative interviews with 8 MLP students and 5 lecturers and 2 focus group discussions with 16 students to gain insights on perceptions of the usefulness, ease of use, and adequacy of self-directed e-learning and health care practice support accessible through the offline-based tablet. Participants were purposively sampled. Verbatim transcripts were analyzed following hypothesis coding. Results: The eHealth platform (e-platform), comprising e-learning for medical education and health care practice support, was positively received by students and medical lecturers and was seen as a step toward modernizing the MLP program. Tablets enabled equal access to offline learning contents, thus bridging the gap of slow or no internet connections. The study results indicated that the e-platform appears adequate to strengthen medical education within this low-resource setting. However, student self-reported usage was low, and medical lecturer usage was even lower. One stated reason was the lack of training in tablet usage and another was the quality of the tablets. The mediocre quality and quantity of most e-learning contents were perceived as a primary concern as materials were reported to be outdated, missing multimedia features, and addressing only part of the curriculum. Medical lecturers were noted to have little commitment to updating or creating new learning materials. Suggestions for improving the e-platform were given. Conclusions: To address identified major challenges, we plan to (1) introduce half-day training sessions at the beginning of each study year to better prepare users for tablet usage, (2) further update and expand e-learning content by fostering collaborations with MLP program stakeholders and nominating an e-platform coordinator, (3) set up an e-platform steering committee including medical lecturers, (4) incorporate e-learning and e-based health care practice support across the curriculum, as well as (5) implement processes to promote user-generated content. With these measures, we aim to sustainably strengthen the MLP program by implementing the tablet-based e-platform as a serious learning technology for medical education and health care practice support. ", doi="10.2196/12637", url="http://mhealth.jmir.org/2019/1/e12637/" } @Article{info:doi/10.2196/12449, author="Barteit, Sandra and Jahn, Albrecht and Banda, S. Sekelani and B{\"a}rnighausen, Till and Bowa, Annel and Chileshe, Geoffrey and Guzek, Dorota and Jorge, Mendes Margarida and L{\"u}ders, Sigrid and Malunga, Gregory and Neuhann, Florian", title="E-Learning for Medical Education in Sub-Saharan Africa and Low-Resource Settings: Viewpoint", journal="J Med Internet Res", year="2019", month="Jan", day="09", volume="21", number="1", pages="e12449", keywords="medical e-learning", keywords="technology-enhanced learning", keywords="blended learning", keywords="health workers", keywords="health system strengthening", keywords="universal health coverage", keywords="medical education", keywords="mHealth", keywords="eHealth", keywords="developing countries", keywords="sub-Saharan Africa", keywords="low-resource countries", doi="10.2196/12449", url="http://www.jmir.org/2019/1/e12449/", url="http://www.ncbi.nlm.nih.gov/pubmed/30626565" } @Article{info:doi/10.2196/10222, author="Barteit, Sandra and Jahn, Albrecht and Bowa, Annel and L{\"u}ders, Sigrid and Malunga, Gregory and Marimo, Clemence and Wolter, Sigrid and Neuhann, Florian", title="How Self-Directed e-Learning Contributes to Training for Medical Licentiate Practitioners in Zambia: Evaluation of the Pilot Phase of a Mixed-Methods Study", journal="JMIR Med Educ", year="2018", month="Nov", day="27", volume="4", number="2", pages="e10222", keywords="evaluation", keywords="medical e-learning", keywords="intervention", keywords="sustainability", keywords="effectiveness", keywords="adoption", keywords="health care workers", keywords="rural health", keywords="sub-Saharan Africa", abstract="Background: Zambia faces a severe shortage of health workers, particularly in rural areas. To tackle this shortage, the Medical Licentiate program was initiated at Chainama College of Health Sciences in the capital, Lusaka, in 2002. The objective of the program was to alleviate the shortage of human resources in curative care. On-the-job training is conducted in decentralized teaching hospitals throughout Zambia. However, the program faces significant challenges such as shortages of senior medical instructors and learning materials. Objective: Our aim was to address these challenges by introducing a self-directed, e-learning platform with an offline tablet as part of a collaborative blended-learning intervention to supplement local teaching and training. Methods: The pilot phase of the e-learning platform was evaluated using a mixed-methods approach with a convergent parallel design. Various methods were employed to test the data's adequacy and potential for generating valid results. Methods included questionnaires according to the technology acceptance model and information system success model by DeLone and McLean, semistructured interviews, learner diaries, pretesting, the collection of usage data, exam results, demographics, and informal feedback. Outcome measures included usage, adoption, efficiency, acceptance, user-friendliness, and gained knowledge and skills. Results: In total, 52 students and 17 medical instructors participated in the pilot evaluation. The questionnaire results showed a high acceptance of the technology (>80\%) and high agreement (>75\%) with the e-learning platform. Semistructured interview results showed an overall appreciation of the e-learning intervention, but the need for more e-learning materials. Respondents identified a need for multimedia materials that transfer skills such as medical procedure visualization and interactive exercises to practice procedural knowledge. The learning diaries identified the lack of specific learning materials and potential shortcomings of existing learning materials. However, students were satisfied with the current e-learning content. The majority of students used the e-learning platform offline on their tablets; online e-learning was underutilized. Conclusions: The pilot phase of the tablet-based e-learning platform to support the self-directed learning intervention was well received and appreciated by students and medical instructors of Chainama College of Health Sciences. E-learning for knowledge acquisition appears to be adequate and feasible for this low-resource educational environment. Our evaluation results guide the further development of the full implementation of the e-learning platform in this educational setting. E-learning materials should reflect curriculum requirements, and additional multimedia and interactive content is needed, as well as improved integration and active participation from medical instructors in the e-learning processes. ", doi="10.2196/10222", url="http://mededu.jmir.org/2018/2/e10222/", url="http://www.ncbi.nlm.nih.gov/pubmed/30482744" }