%0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 3 %P e18313 %T Immersive Virtual Reality for the Reduction of State Anxiety in Clinical Interview Exams: Prospective Cohort Study %A Concannon,Brendan Joseph %A Esmail,Shaniff %A Roduta Roberts,Mary %+ Department of Occupational Therapy, University of Alberta, 8205 - 114 St 2-64 Corbett Hall, Edmonton, AB, T6G 2G4, Canada, 1 780 492 2499, mroberts@ualberta.ca %K virtual reality %K VR %K head-mounted display %K HMD %K immersive technology %K occupational therapy %K OSCE %K simulation %K psychology %K anxiety %D 2020 %7 9.7.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Immersive virtual reality (VR) with head-mounted display was used to determine if clinical interview simulation could reduce the anxiety levels of first-year occupational therapy (OT) students as they prepared for upcoming Objective Structured Clinical Examinations (OSCEs). Anxiety among health science students is a potential problem that may diminish their performance during OSCEs. This investigation aimed to fill the gap in the literature regarding the effectiveness of VR to reduce anxiety in OT students. Objective: This investigation aimed to uncover the effectiveness of immersive VR in reducing state anxiety in OT students who were preparing for OSCEs. Methods: A prospective, experimental, nonrandomized controlled trial compared levels of state anxiety, test anxiety, and academic self-efficacy in two groups of first-year OT students; these levels were measured at four different time points by self-reported psychometric scales, analyzed with a mixed factorial analysis of variance (ANOVA). Members of Phase 1 (NoVR) were not exposed to the VR simulation and acted as a control group for members of Phase 2 (YesVR), who were exposed to the VR simulation. VR simulation featured a virtual clinic and a standardized patient who students could interview in natural language. Measures of student study strategies and previous experience with VR were also recorded. Results: A total of 49 participants—29 in the NoVR group and 20 in the YesVR group—showed that state anxiety had a rise-then-fall trend, peaking at the time point just before the OSCE. At that point, the YesVR students showed significantly less state anxiety than did the NoVR students (t46.19=2.34, P=.02, Cohen d=0.65, ηp2=0.105). The mean difference was 6.78 units (95% CI 0.96-12.61). In similar trends for both groups, student test anxiety remained relatively static across the time points, while academic self-efficacy continually increased. A moderate positive correlation was found for total time spent studying and peak state anxiety (NoVR r=.46, n=28, P=.01; YesVR r=.52, n=19, P=.02). Conclusions: This investigation shows evidence of immersive VR’s capability to reduce state anxiety in OT students preparing for clinical practical exams. Immersive VR simulation, used for the reduction of anxiety in health science students, can potentially lead to a future of positive mental health change from the virtual to the real world. %R 10.2196/18313 %U http://games.jmir.org/2020/3/e18313/ %U https://doi.org/10.2196/18313 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e18358 %T Teaching the National Institutes of Health Stroke Scale to Paramedics (E-Learning vs Video): Randomized Controlled Trial %A Koka,Avinash %A Suppan,Laurent %A Cottet,Philippe %A Carrera,Emmanuel %A Stuby,Loric %A Suppan,Mélanie %+ Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, 1211, Switzerland, 41 795532579, laurent.suppan@hcuge.ch %K active learning %K electronic learning %K video %K stroke %K online learning %K e-learning %D 2020 %7 9.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Prompt and accurate identification of stroke victims is essential to reduce time from symptom onset to adequate treatment and to improve neurological outcomes. Most neurologists evaluate the extent of neurological deficit according to the National Institutes of Health Stroke Scale (NIHSS), but the use of this scale by paramedics, the first healthcare providers to usually take care of stroke victims, has proven unreliable. This might be, at least in part, due to the teaching method. The video used to teach NIHSS lacks interactivity, while more engaging electronic learning (e-learning) methods might improve knowledge acquisition. Objective: This study was designed to evaluate whether a highly interactive e-learning module could enhance NIHSS knowledge acquisition in paramedics. Methods: A randomized controlled trial comparing a specially designed e-learning module with the original NIHSS video was performed with paramedics working in Geneva, Switzerland. A registration number was not required as our study does not come into the scope of the Swiss federal law on human research. The protocol was nevertheless submitted to the local ethics committee (Project ID 2017-00847), which issued a “Declaration of no objection.” Paramedics were excluded if they had prior knowledge of or previous training in the NIHSS, or if they had worked in a neurology or neurosurgery ward. The primary outcome was overall performance in the study quiz, which contained 50 questions. Secondary outcomes were performance by NIHSS item, time to course and quiz completion, user satisfaction regarding the learning method, user perception of the course duration, and probability the user would recommend the course to a colleague. Results: The study was completed by 39 paramedics. There was a better overall median score (36/50 vs 33/50, P=.04) and a higher degree of satisfaction regarding the learning method in the e-learning group (90% vs 37%, P=.002). Users who had followed the e-learning module were more likely to recommend the course to a colleague (95% vs 63%, P=.02). Paramedics in the e-learning group took more time to complete the course (93 vs 59 minutes, P<.001), but considered the duration to be more adequate (75% vs 32%, P=.01). Time to quiz completion was similar between groups (25 vs 38 minutes, P=.12). Conclusions: Use of an e-learning module shows promising results in teaching the NIHSS to paramedics. %M 32299792 %R 10.2196/18358 %U http://www.jmir.org/2020/6/e18358/ %U https://doi.org/10.2196/18358 %U http://www.ncbi.nlm.nih.gov/pubmed/32299792 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 6 %P e15408 %T Nurse-Led Education and Engagement for Diabetes Care in Sub-Saharan Africa: Protocol for a Mixed Methods Study %A Singh,Arti %A Nichols,Michelle %+ College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St, MSC 160, Charleston, SC, 29425, United States, 1 8437921802, nicholmg@musc.edu %K diabetes %K mobile health %K Ghana %K sub-Saharan Africa %K global health %K nurses %K task-shifting %K mixed methods %K focused ethnography %D 2020 %7 3.6.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: As the impact of diabetes grows steeply in sub-Saharan Africa, improvement of the control and treatment of diabetes is a goal that health care systems in sub-Saharan Africa must achieve in the near future. Sub-Saharan Africa faces a number of challenges in addressing the increasing effects of diabetes. One important factor is the shortage of adequately trained health care workers. Diabetes management in sub-Saharan Africa would benefit from innovative approaches that are founded upon solid theoretical constructs, built upon existing human resources and infrastructure, and culturally tailored to the priorities and needs of the local population. Existing resources, such as mobile phones and task-shifting strategies, may be used to assist individuals with glycemic self-management and to facilitate management of additional day-to-day clinical responsibilities. Objective: The objective of the Nurse-Led Education and Engagement Study for Diabetes Care (NEEDS) mixed-methods protocol is to develop a practical, collaborative, effective, and sustainable program for diabetes prevention and management specifically for patients with type 2 diabetes mellitus in sub-Saharan Africa. The protocol aims to improve access to care through task-shifting strategies and the use of mobile health technology. Methods: This study was designed using a convergent parallel mixed-methods approach that consisted of surveys, key informant interviews, focus group discussions, and focused ethnography. Novel approaches, such as task-shifting strategies and the use of mobile technology, were implemented for type 2 diabetes mellitus health care in sub-Saharan Africa—currently an under-researched area. Results: Data collection began in February 2018, after ethics approval, at the Kwame Nkrumah University of Science and Technology. As of May 2020, participant surveys have been completed (N=100), key informant interviews (n=7) have been completed, and focus groups (5 focus groups; patients, n=18; caregivers, n=6; community leaders, n=2; and faith leaders, n=3) as well as focused ethnographic field observations have been completed. All audio recordings have been transcribed and transcripts of sessions recorded in Twi have been translated to English. Data analysis is currently underway and anticipated completion is in the spring of 2020. Following data analysis, investigators plan to publish study findings. Conclusions: Insights from this study will inform the preliminary development of a feasible and effective nurse-led education and engagement mobile health intervention that has the potential to reduce diabetes-related morbidity, mortality, and burden in sub-Saharan Africa. International Registered Report Identifier (IRRID): DERR1-10.2196/15408 %M 32442137 %R 10.2196/15408 %U https://www.researchprotocols.org/2020/6/e15408 %U https://doi.org/10.2196/15408 %U http://www.ncbi.nlm.nih.gov/pubmed/32442137 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e16772 %T Facebook as a Novel Tool for Continuous Professional Education on Dementia: Pilot Randomized Controlled Trial %A Chan,Windy SY %A Leung,Angela YM %+ School of Health Sciences, Caritas Institute of Higher Education, 2 Chui Ling Lane, Tseung Kwan O, New Territories, China (Hong Kong), 852 36536664, sychan@cihe.edu.hk %K dementia %K Facebook %K social network sites %K continuous professional education %D 2020 %7 2.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Social network sites (SNSs) are widely exploited in health education and communication by the general public, including patients with various conditions. Nevertheless, there is an absence of evidence evaluating SNSs in connecting health professionals for professional purposes. Objective: This pilot randomized controlled trial was designed to evaluate the feasibility of an intervention aiming to investigate the effects of a continuous professional education program utilizing Facebook to obtain knowledge on dementia and care for patients with dementia. Methods: Eighty health professionals from Hong Kong were recruited for participation in the study and randomized at a 1:1 ratio by a block randomization method to the intervention group (n=40) and control group (n=40). The intervention was an 8-week educational program developed to deliver updated knowledge on dementia care from a multidisciplinary perspective, either by Facebook (intervention group) or by email (control group) from October 2018 to January 2019. The primary outcomes were the effects of the intervention, measured by differences in the means of changes in pre- and postintervention scores of knowledge assessments from the 25-item Dementia Knowledge Assessment Scale (DKAS) and formative evaluation of 20 multiple choice questions. Other outcome measurements included participant compliance, participant engagement in Facebook, satisfaction, and self-perceived uses of Facebook for continuing professional education programs. Results: Significantly more intervention group participants (n=35) completed the study than the control group (n=25) (P<.001). The overall retention rate was 75% (60/80). The mean of changes in scores in the intervention group were significant in all assessments (P<.001). A significant difference in the mean of changes in scores between the two groups was identified in the DKAS subscale Communication and Behavior (95% CI 0.4-3.3, P=.02). There was no significant difference in the total DKAS scores, scores of other DKAS subscales, and multiple choice questions. Participant compliance was significantly higher in the intervention group than in the control group (P<.001). The mean numbers of participants accessing the learning materials were 31.5 (SD 3.9) and 17.6 (SD 5.2) in the intervention and control group, respectively. Polls attracted the highest level of participant engagement, followed by videos. Intervention group participants scored significantly higher in favoring the use of Facebook for the continuing education program (P=.03). Overall, participants were satisfied with the interventions (mean score 4 of a total of 5, SD 0.6). Conclusions: The significantly higher retention rate, together with the high levels of participant compliance and engagement, demonstrate that Facebook is a promising tool for professional education. Education delivered through Facebook was significantly more effective at improving participants’ knowledge of how people with dementia communicate and behave. Participants demonstrated positive attitudes toward utilizing Facebook for professional learning. These findings provide evidence for the feasibility of using Facebook as an intervention delivery tool in a manner that can be rolled out into practical settings. %M 32484441 %R 10.2196/16772 %U https://www.jmir.org/2020/6/e16772 %U https://doi.org/10.2196/16772 %U http://www.ncbi.nlm.nih.gov/pubmed/32484441 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 6 %N 1 %P e16946 %T Finding the Best Way to Deliver Online Educational Content in Low-Resource Settings: Qualitative Survey Study %A Kynge,Lucy %+ Interburns, Swansea University, Haldane Building, Swansea, SA2 8PP, United Kingdom, 44 07742437420, lucy.kynge@interburns.org %K online education %K digital content %K health care %K burns %K low-resource settings %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Med Educ %G English %X 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. %M 32452810 %R 10.2196/16946 %U http://mededu.jmir.org/2020/1/e16946/ %U https://doi.org/10.2196/16946 %U http://www.ncbi.nlm.nih.gov/pubmed/32452810 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e19076 %T Global Reach of an Online COVID-19 Course in Multiple Languages on OpenWHO in the First Quarter of 2020: Analysis of Platform Use Data %A Utunen,Heini %A Ndiaye,Ngouille %A Piroux,Corentin %A George,Richelle %A Attias,Melissa %A Gamhewage,Gaya %+ Learning and Capacity Development Unit, World Health Organization Health Emergencies Programme, World Health Organization, 20 Avenue Appia, Geneva, 1211, Switzerland, 41 795933476, utunenh@who.int %K online learning %K OpenWHO %K novel coronavirus %K COVID-19 %K coronavirus %K pandemic %K WHO %K e-learning %K MOOC %K public health %D 2020 %7 27.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: At the onset of the coronavirus outbreak, the World Health Organization’s (WHO) Health Emergencies Learning and Capacity Development Unit, together with the WHO’s health technical lead on coronaviruses, developed a massive open online course within 3 weeks as part of the global response to the emergency. The introductory coronavirus disease (COVID‑19) course was launched on January 26, 2020, on the health emergencies learning platform OpenWHO.org. Objective: The aim of this paper is to investigate the geographic reach of different language courses accessed by a worldwide audience seeking information on COVID-19. Users’ professional identities and backgrounds were explored to inform course owners on the use case. The course was developed and delivered via the open-access learning platform OpenWHO.org. The self-paced resources are available in a total of 13 languages and were produced between January 26 and March 25, 2020. Methods: Data were collected from the online courses’ statistical data and metrics reporting system on the OpenWHO platform. User patterns and locations were analyzed based on Google Analytics and the platform’s own statistics capabilities, and data sets were overlaid. This analysis was conducted based on user location, with the data disaggregated according to the six WHO regions, the top 10 countries, and the proportion of use for each language version. Data included affiliation, gender, age, and other parameters for 32.43% (52,214/161,007) of the users who indicated their background. Results: As of March 25, 2020, the introductory COVID-19 course totaled 232,890 enrollments across all languages. The Spanish language course was comprised of more than half (n=118,754, 50.99%) of all course enrollments, and the English language course was comprised of 38.21% (n=88,988) of enrollments. The WHO’s Region of the Americas accounted for most of the course enrollments, with more than 72.47% (138,503/191,130) enrollment across all languages. Other regions were more evenly distributed with less than 10% enrollment for each. A total of 32.43% (52,214/161,007) of users specified a professional affiliation by choosing from the 12 most common backgrounds in the OpenWHO user profiles. Before the COVID-19 pandemic, users were spread over the 11 distinct affiliations, with a small fraction of users identifying themselves as “Other.” With the COVID-19 introductory course, the largest number of users selected “Other” (16,527/52,214, 31.65%), suggesting a large number of users who were not health professionals or academics. The top 10 countries with the most users across all languages were Argentina, Chile, Colombia, Ecuador, India, Mexico, Peru, Spain, the United Kingdom, and the United States. Conclusions: The online course has addressed a worldwide learning need by providing WHO’s technical guidance packaged in simple formats for access and use. The learning material development was expedited to meet the onset of the epidemic. Initial data suggest that the various language versions of the course, in particular Spanish, have reached new user groups, fulfilling the platform’s aim of providing learning everywhere to anyone that is interested. User surveys will be carried out to measure the real impact. %M 32293580 %R 10.2196/19076 %U https://www.jmir.org/2020/4/e19076 %U https://doi.org/10.2196/19076 %U http://www.ncbi.nlm.nih.gov/pubmed/32293580 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e18604 %T A Clinical Teaching Blended Learning Program to Enhance Registered Nurse Preceptors’ Teaching Competencies: Pretest and Posttest Study %A Wu,Xi Vivien %A Chi,Yuchen %A Panneer Selvam,Umadevi %A Devi,M Kamala %A Wang,Wenru %A Chan,Yah Shih %A Wee,Fong Chi %A Zhao,Shengdong %A Sehgal,Vibhor %A Ang,Neo Kim Emily %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 66012756, nurwux@nus.edu.sg %K blended learning %K case-based learning %K clinical pedagogy %K clinical teaching competency %K web-based program %K nurse preceptor %D 2020 %7 24.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Clinical nursing education provides opportunities for students to learn in multiple patient care settings, receive appropriate guidance, and foster the development of clinical competence and professionalism. Nurse preceptors guide students to integrate theory into practice, teach clinical skills, assess clinical competencies, and enhance problem-solving and critical thinking skills. Previous research has indicated that the teaching competencies of nurse preceptors can be transferred to students’ clinical learning to enhance their clinical competencies. Objective: This study aimed to develop a clinical teaching blended learning (CTBL) program with the aid of web-based clinical pedagogy (WCP) and case-based learning for nurse preceptors and to examine the effectiveness of the CTBL program on nurse preceptors’ clinical teaching competencies, self-efficacies, attitudes toward web-based learning, and blended learning outcomes. Methods: A quasi-experimental single-group pretest and posttest design was adopted. A total of 150 nurse preceptors participated in the CTBL program, which was conducted from September 2019 to December 2019. A set of questionnaires, including the clinical teaching competence inventory, preceptor self-efficacy questionnaire, attitudes toward web-based continuing learning survey, and e-learning experience questionnaire, was used to assess the outcomes before and after the CTBL program. Results: Compared with the baseline, the participants had significantly higher total mean scores and subdomain scores for clinical teaching competence (mean 129.95, SD 16.38; P<.001), self-efficacy (mean 70.40, SD 9.35; P<.001), attitudes toward web-based continuing learning (mean 84.68, SD 14.76; P<.001), and blended learning outcomes (mean 122.13, SD 14.86; P<.001) after the CTBL program. Conclusions: The CTBL program provides a comprehensive coverage of clinical teaching pedagogy and assessment strategies. The combination of the WCP and case-based approach provides a variety of learning modes to fit into the diverse learning needs of the preceptors. The CTBL program allows the preceptors to receive direct feedback from the facilitators during face-to-face sessions. Preceptors also gave feedback that the web-based workload is manageable. This study provides evidence that the CTBL program increases the clinical teaching competencies and self-efficacies of the preceptors and promotes positive attitudes toward web-based learning and better blended learning outcomes. The health care organization can consider the integration of flexible learning and intellect platforms for preceptorship education. %M 32329743 %R 10.2196/18604 %U http://www.jmir.org/2020/4/e18604/ %U https://doi.org/10.2196/18604 %U http://www.ncbi.nlm.nih.gov/pubmed/32329743 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 6 %N 1 %P e15877 %T Current and Future Trends in Life Sciences Training: Questionnaire Study %A Magagna,William %A Wang,Nicole %A Peck,Kyle %+ Department of Learning Performance System, Pennsylvania State University, Keller Building, University Park, PA, United States, 1 2154072119, nwang@psu.edu %K professional training %K training with technologies %K life sciences professionals %K mixed methods %D 2020 %7 24.4.2020 %9 Original Paper %J JMIR Med Educ %G English %X Background: Every year, the life science field spends billions of dollars on educational activities worldwide. The continuing professional development of employees, especially in this field, encompasses great challenges. Emerging technologies appear to offer opportunity, but relatively little research has been done on the effectiveness of pedagogies and tools that have been used in the life sciences, and even less research has been devoted to understanding the potential power of emerging options that might determine the field’s future. Objective: In collaboration with the Life Sciences Trainers & Educators Network (LTEN), this study investigated the current state of the pedagogies and tools currently adopted by corporate training professionals in the life sciences as well as the professionals’ perceptions of the impacts of emerging technologies on training. Methods: This study adopted a mixed methods approach that included a survey and a follow-up interview. The survey consists of 18 broad questions with 15 subquestions in each of the five specific sectors of the life sciences field. Interviews were conducted by phone and lasted approximately 40 minutes, covering 18 questions designed to follow-up on findings from the survey items. Results: Both survey and interview results indicated that the professionals were not satisfied with the status quo and that training and education in this field need to change. Most of the techniques and tools currently used have been used for some time. The professionals surveyed were not satisfied with the current techniques and tools and did not find them cost-effective. In addition, the respondents pictured the future of training in this field to be more engaging and effective. Conclusions: This is the first study in a series designed to better understand education and training in the life sciences on a macro level, in order to build a foundation for progress and evolution of the future landscape. Next steps involve developing strategies for how to extend this vision throughout individual organizations. %M 32329739 %R 10.2196/15877 %U http://mededu.jmir.org/2020/1/e15877/ %U https://doi.org/10.2196/15877 %U http://www.ncbi.nlm.nih.gov/pubmed/32329739 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e16808 %T A Web-Based Dementia Education Program and its Application to an Australian Web-Based Dementia Care Competency and Training Network: Integrative Systematic Review %A Moehead,Anne %A DeSouza,Kathryn %A Walsh,Karen %A Pit,Sabrina W %+ Northern New South Wales Local Health District, New South Wales Ministry of Health, Uralba St, Lismore, 2480, Australia, 61 429449591, gmo11800@dodo.com.au %K education %K workforce %K online learning %K Web-based learning %K distance education %K dementia %K nursing %K facilitated learning %K competency %K training %K network %K capability %K skills %K person-centered %D 2020 %7 22.1.2020 %9 Review %J J Med Internet Res %G English %X Background: Dementia education that meets quality and safety standards is paramount to ensure a highly skilled dementia care workforce. Web-based education provides a flexible and cost-effective medium. To be successful, Web-based education must contain features that promote learning and support knowledge translation into practice. The Dementia Care Competency and Training Network (DCC&TN) has developed an innovative Web-based program that promotes improvement of the attitudes, knowledge, skills, behavior, and practice of clinicians, regardless of their work setting, in order to improve the quality of life for people living with dementia. Objective: This review aims to (1) determine the key features that are associated with an effective and functional Web-based education program—an effective and functional Web-based program is defined as one that measures results, is accessible, is user friendly, and translates into clinical practice—and (2) determine how these features correlate with the DCC&TN. Methods: Six electronic databases—Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), AusHealth, Nursing@Ovid, and Google Scholar—were searched for articles published between 2009 and 2018 using the following keywords: Education, Distance, Continuing, Learning, Online, Web-Based, Internet, Dementia, Program Evaluation, Validation Studies, Outcome and Process Assessment Healthcare, Nursing, Assisted Instruction, and Facilitated. The Critical Appraisal Skills Programme (CASP) and Kirkpatrick’s model for the evaluation of training were used to ensure quality and rigor of the analysis. Results: A total of 46 studies met the inclusion criteria. In total, 14 key features were associated with an effective Web-based learning environment, which enabled the environment to be as follows: self-directed, individualized, interactive, multimodal, flexible, accessible, consistent, cost-effective, measurable with respect to participant satisfaction, equitable, facilitated, nurturing of critical thinking and reflection, supportive of creating a learning community, and translated into practice. These features were further categorized into five subgroups: applicability, attractiveness, functionality, learner interaction, and implementation into practice. Literature frequently cites Kirkpatrick’s four-level model of evaluation and application in the review of education and training; however, few studies appeared to integrate all four levels of Kirkpatrick’s model. Features were then correlated against the DCC&TN, with an encouraging connection found between these features and their inclusion within the content and structure of the DCC&TN. Conclusions: A total of 14 key features were identified that support an effective and functional Web-based learning environment. Few studies incorporated Kirkpatrick’s salient elements of the model—reaction, learning, behavior, and results—in their evaluation and clinical application. It could, therefore, be considered prudent to include Kirkpatrick’s levels of training evaluation within studies of dementia training. There were few studies that evaluated Web-based dementia education programs, with even fewer reporting evidence that Web-based training could increase staff confidence, knowledge, skills, and attitudes toward people with dementia and be sustainable over time. The DCC&TN appeared to contain the majority of key features and is one of the few programs inclusive of hospital, community, and residential care settings. The 14 key features can potentially enhance and complement future development of online training programs for health sciences education and beyond. The DCC&TN model could potentially be used as a template for future developers and evaluators of Web-based dementia training. %M 32012077 %R 10.2196/16808 %U http://www.jmir.org/2020/1/e16808/ %U https://doi.org/10.2196/16808 %U http://www.ncbi.nlm.nih.gov/pubmed/32012077 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e15828 %T The mPOWERED Electronic Learning System for Intimate Partner Violence Education: Mixed Methods Usability Study %A Hughes,Charmayne %A Musselman,Elaine A %A Walsh,Lilia %A Mariscal,Tatiana %A Warner,Sam %A Hintze,Amy %A Rashidi,Neela %A Gordon-Murer,Chloe %A Tanha,Tiana %A Licudo,Fahrial %A Ng,Rachel %A Tran,Jenna %+ Health Equity Institute, San Francisco State University, 1600 Holloway Ave, Department of Kinesiology, San Francisco, CA, 94132, United States, 1 4157708121, cmhughes@sfsu.edu %K intimate partner violence %K domestic violence %K nursing education %K learning %D 2020 %7 3.1.2020 %9 Original Paper %J JMIR Nursing %G English %X Background: Nurse practitioners are a common resource for victims of intimate partner violence (IPV) presenting to health care settings. However, they often have inadequate knowledge about IPV and lack self-efficacy and confidence to be able to screen for IPV and communicate effectively with patients. Objective: The aim of this study was to develop and test the usability of a blended learning system aimed at educating nurse practitioner students on topics related to IPV (ie, the mPOWERED system [Health Equity Institute]). Methods: Development of the mPOWERED system involved usability testing with 7 nurse educators (NEs) and 18 nurse practitioner students. Users were asked to complete usability testing using a speak-aloud procedure and then complete a satisfaction and usability questionnaire. Results: Overall, the mPOWERED system was deemed to have high usability and was positively evaluated by both NEs and nurse practitioner students. Respondents provided critical feedback that will be used to improve the system. Conclusions: By including target end users in the design and evaluation of the mPOWERED system, we have developed a blended IPV learning system that can easily be integrated into health care education. Larger-scale evaluation of the pedagogical impact of this system is underway. %R 10.2196/15828 %U https://nursing.jmir.org/2020/1/e15828 %U https://doi.org/10.2196/15828 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 10 %P e11963 %T A Web-Based Alcohol Screening and Brief Intervention Training Module Within Physician Assistant Programs in the Midwest to Increase Knowledge, Attitudes, and Confidence: Evaluation Study %A Tenkku Lepper,Leigh E %A Cleveland,Tracy %A DelRosario,Genevieve %A Ervie,Katherine %A Link,Catherine %A Oakley,Lara %A Elfagir,Abdelmoneim %A Sprague,Debra J %+ School of Social Work and Public Health Program, University of Missouri-Columbia, 707 Clark Hall, Columbia, MO, 65211, United States, 1 5738845459, tenkkul@missouri.edu %K alcohol education %K alcohol screening and brief intervention %K Web-based training %K standardized patient %K physician assistant %D 2019 %7 23.10.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Preventing and reducing risky alcohol use and its side effects remains a public health priority. Discussing alcohol use with patients can be difficult; dedicated training for health care providers is needed to facilitate these conversations. A Web-based alcohol screening and brief intervention (SBI), comprising didactic and skills application training, was designed for physician assistant students. Objective: This paper details experiences and outcomes in developing an alcohol SBI training curriculum and coordinating virtual encounters with standardized patients. We also explain challenges faced with developing an alcohol SBI training and a Web-based learning management site to fit the needs of 5 different physician assistant programs. Methods: Training development comprised 3 phases—precourse, development, and implementation. The precourse phase included developing the initial training curriculum, building a website, and testing with a pilot group. The development phase refined the training curriculum based on user feedback and moved into a three-component module: didactic training module, guided interactive encounter with a simulated patient, and live encounter with a standardized patient. A learning management system website was also created. In the implementation phase, 5 physician assistant schools incorporated the Web-based training into curricula. Each school modified the implementation method to suit their organizational environment. Evaluation methods included pre- and postchange over time on trainee attitudes, knowledge, and skills (confidence) on talking to patients about alcohol use, trainee self-reported proficiency on the standardized patient encounter, standardized patient evaluation of the trainee proficiency during the alcohol use conversation, user evaluation of the type of technology mode for the standardized patient conversation, and overall trainee satisfaction with the Web-based training on alcohol SBI. Results: Final evaluation outcomes indicated a significant (P<.01) change over time in trainee knowledge and skills (confidence) in the conduct of the alcohol SBI with a standardized patient, regardless of the program implementation method. Trainees were generally satisfied with the Web-based training experience and rated the use of the videoconference medium as most useful when conducting the alcohol SBI conversation with the standardized patient. Training that included a primer on the importance of screening, individual participation in the Web-based didactic alcohol SBI modules, and virtual encounters with standardized patients through a university-based simulation center was the most widely accepted. Successful implementation included program investment and curriculum planning. Implementation barriers involved technical challenges with standardized patient encounters and simulation center logistics, and varying physician assistant school characteristics. Conclusions: Development and implementation of Web-based educational modules to educate health care professionals on alcohol SBI is effective, easy to reproduce, and readily accessible. Identifying challenges affecting development, implementation, and utilization of learned techniques in practice, enhances facilitation of learning and training efficacy. As the value of technology-based learning becomes more apparent, reports detailing what has worked versus what has not may help guide the process. %M 31647473 %R 10.2196/11963 %U http://mental.jmir.org/2019/10/e11963/ %U https://doi.org/10.2196/11963 %U http://www.ncbi.nlm.nih.gov/pubmed/31647473 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e14451 %T Impact of Training of Primary Health Care Centers’ Vaccinators on Immunization Session Practices in Wasit Governorate, Iraq: Interventional Study %A Amily,Ali Sadiq %A Lami,Faris %A Khader,Yousef %+ Immunization Section, Wasit Directorate of Health, Iraqi Ministry of Health, Tamooz, Kut, Iraq, 964 7813928919, amily_ali@yahoo.com %K immunization %K primary health care %K intervention %K practices %K Iraq %D 2019 %7 7.10.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Immunization averts more than 2.5 million deaths of children annually. The World Health Organization (WHO) and the United Nations Children’s Fund estimates of immunization coverage in Iraq in 2015 revealed a 58% coverage for the third dose of the diphtheria-tetanus-pertussis vaccine and a 57% coverage for the measles vaccine. High-quality immunization session practices (ISPs) can ensure safer, more effective vaccination and higher coverage rates. Objective: The goal of this study was to assess the impact of training of primary health care centers’ (PHCs) vaccinators on the quality of ISPs. Methods: This was an interventional study conducted on 10 (18%) PHCs in Wasit Governorate. Two PHCs were randomly selected from each health district. ISPs were assessed by direct on-job observation, using modified WHO immunization session checklists. Findings were grouped into seven domains: vaccine and diluent management, cold chain management, session equipment, registration, communication, vaccine preparation and administration, and waste management. The vaccinators were enrolled in a one-day training session using the WHO module, “Managing an Immunization Session”, and one month later a second assessment was conducted using the same tools and techniques. We then calculated the median differences of the domains' scores. Results: A total of 42 vaccinators were trained, with 25 (60%) of them having graduated from technical health institutes, but only 15 (36%) having had previous training on standard ISPs. Following training, a significant improvement was noticed in three domains: vaccines and diluents management (P=.01), cold chain management (P=.01) and vaccine preparation and administration (P=.02). Conclusions: The training of the PHCs' vaccinators for a single day was effective in improving some ISPs. We would recommend using this training module, or a more in-depth one, for other PHCs to improve utilization of immunization services. %M 31593540 %R 10.2196/14451 %U https://publichealth.jmir.org/2019/4/e14451 %U https://doi.org/10.2196/14451 %U http://www.ncbi.nlm.nih.gov/pubmed/31593540 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e15118 %T Effects of E-Learning in a Continuing Education Context on Nursing Care: Systematic Review of Systematic Qualitative, Quantitative, and Mixed-Studies Reviews %A Rouleau,Geneviève %A Gagnon,Marie-Pierre %A Côté,José %A Payne-Gagnon,Julie %A Hudson,Emilie %A Dubois,Carl-Ardy %A Bouix-Picasso,Julien %+ Faculty of Nursing, Université Laval, Pavillon Ferdinand-Vandry 1050 Avenue de la Médecine, Quebec, QC, G1V 0A6, Canada, 1 418 656 2131 ext 407576, marie-pierre.gagnon@fsi.ulaval.ca %K continuing education %K e-learning %K nurses %K nursing care %K systematic review of systematic reviews %D 2019 %7 2.10.2019 %9 Review %J J Med Internet Res %G English %X Background: E-learning is rapidly growing as an alternative way of delivering education in nursing. Two contexts regarding the use of e-learning in nursing are discussed in the literature: (1) education among nursing students and (2) nurses’ continuing education within a life-long learning perspective. A systematic review of systematic reviews on e-learning for nursing and health professional students in an academic context has been published previously; however, no such review exists regarding e-learning for registered nurses in a continuing education context. Objective: We aimed to systematically summarize the qualitative and quantitative evidence regarding the effects of e-learning on nursing care among nurses in a continuing education context. Methods: We conducted a systematic review of systematic qualitative, quantitative, and mixed-studies reviews, searching within four bibliographic databases. The eligibility criteria were formulated using the population, interventions, comparisons, outcomes, and study design (PICOS) format. The included population was registered nurses. E-learning interventions were included and compared with face-to-face and any other e-learning interventions, as well as blended learning. The outcomes of interest were derived from two models: nursing-sensitive indicators from the Nursing Care Performance Framework (eg, teaching and collaboration) and the levels of evaluation from the Kirkpatrick model (ie, reaction, learning, behavior, and results). Results: We identified a total of 12,906 records. We retrieved 222 full-text papers for detailed evaluation, from which 22 systematic reviews published between 2008 and 2018 met the eligibility criteria. The effects of e-learning on nursing care were grouped under Kirkpatrick’s levels of evaluation: (1) nurse reactions to e-learning, (2) nurse learning, (3) behavior, and (4) results. Level 2, nurse learning, was divided into three subthemes: knowledge, skills, attitude and self-efficacy. Level 4, results, was divided into patient outcomes and costs. Most of the outcomes were reported in a positive way. For instance, nurses were satisfied with the use of e-learning and they improved their knowledge. The most common topics covered by the e-learning interventions were medication calculation, preparation, and administration. Conclusions: The effects of e-learning are mainly reported in terms of nurse reactions, knowledge, and skills (ie, the first two levels of the Kirkpatrick model). The effectiveness of e-learning interventions for nurses in a continuing education context remains unknown regarding how the learning can be transferred to change practice and affect patient outcomes. Further scientific, methodological, theoretical, and practice-based breakthroughs are needed in the fast-growing field of e-learning in nursing education, especially in a life-learning perspective. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42016050714; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=50714 %M 31579016 %R 10.2196/15118 %U https://www.jmir.org/2019/10/e15118 %U https://doi.org/10.2196/15118 %U http://www.ncbi.nlm.nih.gov/pubmed/31579016 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e14676 %T Virtual Patient Simulations in Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration %A Kononowicz,Andrzej A %A Woodham,Luke A %A Edelbring,Samuel %A Stathakarou,Natalia %A Davies,David %A Saxena,Nakul %A Tudor Car,Lorainne %A Carlstedt-Duke,Jan %A Car,Josip %A Zary,Nabil %+ Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Clinical Science Building, Singapore,, Singapore, 65 6340 2480, josip.car@ntu.edu.sg %K computer simulation %K professional education %K computer-assisted instruction %K systematic review %K meta-analysis %D 2019 %7 02.07.2019 %9 Review %J J Med Internet Res %G English %X Background: Virtual patients are interactive digital simulations of clinical scenarios for the purpose of health professions education. There is no current collated evidence on the effectiveness of this form of education. Objective: The goal of this study was to evaluate the effectiveness of virtual patients compared with traditional education, blended with traditional education, compared with other types of digital education, and design variants of virtual patients in health professions education. The outcomes of interest were knowledge, skills, attitudes, and satisfaction. Methods: We performed a systematic review on the effectiveness of virtual patient simulations in pre- and postregistration health professions education following Cochrane methodology. We searched 7 databases from the year 1990 up to September 2018. No language restrictions were applied. We included randomized controlled trials and cluster randomized trials. We independently selected studies, extracted data, and assessed risk of bias and then compared the information in pairs. We contacted study authors for additional information if necessary. All pooled analyses were based on random-effects models. Results: A total of 51 trials involving 4696 participants met our inclusion criteria. Furthermore, 25 studies compared virtual patients with traditional education, 11 studies investigated virtual patients as blended learning, 5 studies compared virtual patients with different forms of digital education, and 10 studies compared different design variants. The pooled analysis of studies comparing the effect of virtual patients to traditional education showed similar results for knowledge (standardized mean difference [SMD]=0.11, 95% CI −0.17 to 0.39, I2=74%, n=927) and favored virtual patients for skills (SMD=0.90, 95% CI 0.49 to 1.32, I2=88%, n=897). Studies measuring attitudes and satisfaction predominantly used surveys with item-by-item comparison. Trials comparing virtual patients with different forms of digital education and design variants were not numerous enough to give clear recommendations. Several methodological limitations in the included studies and heterogeneity contributed to a generally low quality of evidence. Conclusions: Low to modest and mixed evidence suggests that when compared with traditional education, virtual patients can more effectively improve skills, and at least as effectively improve knowledge. The skills that improved were clinical reasoning, procedural skills, and a mix of procedural and team skills. We found evidence of effectiveness in both high-income and low- and middle-income countries, demonstrating the global applicability of virtual patients. Further research should explore the utility of different design variants of virtual patients. %M 31267981 %R 10.2196/14676 %U https://www.jmir.org/2019/7/e14676/ %U https://doi.org/10.2196/14676 %U http://www.ncbi.nlm.nih.gov/pubmed/31267981 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 5 %N 1 %P e12795 %T Evidence-Based Physical Therapy Practice in the State of Kuwait: A Survey of Attitudes, Beliefs, Knowledge, Skills, and Barriers %A Alrowayeh,Hesham N %A Buabbas,Ali J %A Alshatti,Talal A %A AlSaleh,Fatemah M %A Abulhasan,Jawad F %+ Physical Therapy Department, Faculty of Allied Health Sciences, Kuwait University, Health Science Center, Jabriya, 46300, Kuwait, 965 97960000, hrowayeh@hsc.edu.kw %K physical therapy practice %K evidence-based practice %K attitudes %K knowledge %D 2019 %7 07.06.2019 %9 Original Paper %J JMIR Med Educ %G English %X Background: Evidence-based practice (EBP) is necessary to improve the practice of physical therapy. However, a lack of knowledge and skills among physical therapists and the presence of barriers may hinder the implementation of EBP in the State of Kuwait. Objective: The objectives of this study were to extensively (1) investigate attitudes toward EBP, (2) assess the current level of knowledge and skills necessary for EBP, and (3) identify the barriers to EBP among physical therapists in the State of Kuwait. Methods: The following methods were used: (1) a previously validated self-reported questionnaire and (2) a face-to-face semistructured interview. The questionnaire, which was distributed to 200 physical therapists, examined the attitudes and beliefs of physical therapists about EBP; the interest in and motivation to engage in EBP; educational background, knowledge, and skills related to accessing and interpreting information; the level of attention to and use of the literature; access to and availability of information to promote EBP; and the perceived barriers to using EBP. The interview explored the factors that promote or discourage EBP. Descriptive statistics and logistic regression analyses were used. Results: Of the 200 nonrandomly distributed questionnaires, 92% (184/200) were completed and returned. In general, the physical therapists had positive attitudes, beliefs, and interests in EBP. Their educational background, knowledge, and skills related to assessing and interpreting information were well-founded. The top 3 barriers included insufficient time (59.2%, 109/184), lack of information resources (49.4%, 91/184), and inapplicability of the research findings to the patient population (40.7%, 75/184). Conclusions: EBP lacks support from superiors at work. Thus, identifying methods and strategies to support physical therapists in adopting EBP in the State of Kuwait is necessary. %M 31237840 %R 10.2196/12795 %U http://mededu.jmir.org/2019/1/e12795/ %U https://doi.org/10.2196/12795 %U http://www.ncbi.nlm.nih.gov/pubmed/31237840 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 5 %P e13480 %T Web-Based Skin Cancer Prevention Training for Massage Therapists: Protocol for the Massage Therapists Skin Health Awareness, Referral, and Education Study %A Loescher,Lois J %A Heslin,Kelly M %A Szalacha,Laura A %A Silva,Graciela E %A Muramoto,Myra L %+ College of Nursing, University of Arizona, 1305 N Martin Ave, Tucson, AZ,, United States, 1 (520) 626 6196, loescher@email.arizona.edu %K skin cancer %K primary prevention %K secondary prevention %K health education %K e-learning %K massage %K web-based learning %K massage therapists %D 2019 %7 15.05.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Skin cancer, the most common cancer in the United States, is costly and potentially deadly. Its burden can be reduced by early detection and prevention activities. The scope of skin cancer requires going beyond traditional health care providers to promote risk reduction. Partnering with the nonbiomedical workforce, such as massage therapists (MTs), may reach more individuals at risk. MTs see much of their clients’ skin and are amenable to performing skin cancer risk reduction activities during massage appointments. Objective: The objective of this study is to describe the Massage Therapists Skin Health Awareness, Referral, and Education protocol, presenting an overview of our systematic approach to developing rigorous e-training for MTs to enable them to be partners in skin cancer risk reduction. We also describe procedures for usability and feasibility testing of the training. Methods: We developed an integrated electronic learning system that includes electronic training (e-training) technology, simulated client interactions, online data collection instruments, and in-person assessment of MTs’ application of their training. Results: A total of 20 participants nationally scored the e-training as high for usability and satisfaction. We have screened an additional 77 MTs in Arizona for interest and eligibility, and currently have 37 enrolled participants, of whom 32 have completed the Web-based training. Conclusions: The structured and rigorous development approach for this skin cancer risk reduction and brief behavioral intervention e-training for MTs begins to fill a gap in skin cancer risk reduction research. Iterative usability testing of our asynchronous Web-based training resulted in positive participant response. Our e-training approach offers greater learner accessibility, increased convenience, and greater scalability than the few existing programs and has the potential to reach many MTs nationally. International Registered Report Identifier (IRRID): DERR1-10.2196/13480 %M 31094348 %R 10.2196/13480 %U http://www.researchprotocols.org/2019/5/e13480/ %U https://doi.org/10.2196/13480 %U http://www.ncbi.nlm.nih.gov/pubmed/31094348 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e13446 %T Internet-Based Cognitive Therapy for Social Anxiety Disorder in Hong Kong: Therapist Training and Dissemination Case Series %A Thew,Graham R %A Powell,Candice LYM %A Kwok,Amy PL %A Lissillour Chan,Mandy H %A Wild,Jennifer %A Warnock-Parkes,Emma %A Leung,Patrick WL %A Clark,David M %+ Department of Experimental Psychology, University of Oxford, The Old Rectory, Paradise Square, Oxford, OX1 1TW, United Kingdom, 44 01865 618600, graham.thew@psy.ox.ac.uk %K anxiety %K social phobia %K internet %K cognitive therapy %K clinical competence %K cross-cultural comparison %K Hong Kong %K benchmarking %K psychology, clinical %K mental health %D 2019 %7 15.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Guided internet-based psychological interventions show substantial promise for expanding access to evidence-based mental health care. However, this can only be achieved if results of tightly controlled studies from the treatment developers can also be achieved in other independent settings. This dissemination depends critically on developing efficient and effective ways to train professionals to deliver these interventions. Unfortunately, descriptions of therapist training and its evaluation are often limited or absent within dissemination studies. Objective: This study aimed to describe and evaluate a program of therapist training to deliver internet-based Cognitive Therapy for social anxiety disorder (iCT-SAD). As this treatment was developed in the United Kingdom and this study was conducted in Hong Kong with local therapists, an additional objective was to examine the feasibility, acceptability, and initial efficacy of iCT-SAD in this cultural context, based on data from a pilot case series. Methods: Training in iCT-SAD was provided to 3 therapists and included practice of the face-to-face format of therapy under clinical supervision, training workshops, and treating 6 patients with the iCT-SAD program. Training progress was evaluated using standardized and self-report measures and by reviewing patient outcomes. In addition, feedback from patients and therapists was sought regarding the feasibility and acceptability of the program. Results: The training program was effective at increasing therapists’ iCT-SAD knowledge and skills, resulting in levels of competence expected of a specialist Cognitive Behavioral Therapy practitioner. The 6 patients treated by the trainees all completed their treatment and achieved a mean pre- to posttreatment change of 53.8 points (SD 39.5) on the primary patient outcome measure, the Liebowitz Social Anxiety Scale. The within-group effect size (Cohen d) was 2.06 (95% CI 0.66-3.46). There was evidence to suggest that the patients’ clinical outcomes were sustained at 3-month follow-up. These clinical results are comparable to those achieved by UK patients treated by the developers of the internet program. Patient and therapist feedback did not identify any major cultural barriers to implementing iCT-SAD in Hong Kong; some modest language suggestions were made to assist understanding. Conclusions: The therapist training implemented here facilitated the successful dissemination of an effective UK-developed internet intervention to Hong Kong. The treatment appeared feasible and acceptable in this setting and showed highly promising initial efficacy. A randomized controlled trial is now required to examine this more robustly. As therapist training is critical to the successful dissemination of internet interventions, further research to develop, describe, and evaluate therapist training procedures is recommended. %M 31094320 %R 10.2196/13446 %U http://formative.jmir.org/2019/2/e13446/ %U https://doi.org/10.2196/13446 %U http://www.ncbi.nlm.nih.gov/pubmed/31094320 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 5 %N 1 %P e13350 %T Exploring Care Providers’ Perceptions and Current Use of Telehealth Technology at Work, in Daily Life, and in Education: Qualitative and Quantitative Study %A Hah,Hyeyoung %A Goldin,Deana %+ Department of Information Systems and Business Analytics, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, United States, 1 3053484342, hyeyoung.hah@gmail.com %K telehealth technology %K nurse practitioners %K daily technology use %K telehealth care performance %K nursing education %D 2019 %7 22.04.2019 %9 Original Paper %J JMIR Med Educ %G English %X Background: A telehealth technology education curriculum designed to integrate information technology and telecommunication well has great potential to prepare care providers for health care delivery across space, time, and social and cultural barriers. It is important to assess the readiness level of care providers to use and maximize the benefits of telehealth technology in the health care delivery process. Therefore, this study explored care providers’ existing experience using technology in various use contexts and compared their familiarity with telehealth technology’s relevant features. Objective: This study’s objective was to explore care providers’ familiarity with using technology in different settings and their perceptions of telehealth-driven care performance to lay a foundation for the design of an effective telehealth education program. Methods: The study used quantitative and qualitative analyses. The online survey included four items that measured care providers’ perceptions of care performance when using telehealth technology. Advanced practice registered nurse students rated each item on a 7-point Likert scale, ranging from 1 (“strongly disagree”) to 7 (“strongly agree”). They also responded to three open-ended questions about what kinds of health information technology they use at work, after work, and in their current educational program. Results: A total of 109 advanced practice registered nurse students responded to the online survey and open-ended questionnaire. Most indicated that using telehealth technology enhances care performance (mean 5.67, median 6.0, SD 1.36), helps make their care tasks more effective (mean 5.73, median 6.0, SD 1.30), improves the quality of performing care tasks (mean 5.71, median 6.0, SD 1.30), and decreases error in communicating and sharing information with others (mean 5.35, median 6.0, SD 1.53). In addition, our qualitative analyses revealed that the students used the electronic health records technology primarily at work, combined with clinical decision support tools for medication and treatment management. Outside work, they primarily used video-text communication tools and were exposed to some telehealth technology in their education setting. Further, they believe that use of nonhealth technology helps them use health information technology to access health information, confirm their diagnoses, and ensure patient safety. Conclusions: This research highlights the importance of identifying care providers’ existing experience of using technology to better design a telehealth technology education program. By focusing explicitly on the characteristics of care providers’ existing technology use in work, nonwork, and educational settings, we found a potential consistency between practice and education programs in care providers’ requirements for technology use, as well as areas of focus to complement their frequent use of nonhealth technologies that resemble telehealth technology. Health policymakers and practitioners need to provide compatible telehealth education programs tailored to the level of care providers’ technological familiarity in both their work and nonwork environments. %M 31008708 %R 10.2196/13350 %U http://mededu.jmir.org/2019/1/e13350/ %U https://doi.org/10.2196/13350 %U http://www.ncbi.nlm.nih.gov/pubmed/31008708 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 5 %N 1 %P e12058 %T Motivating HIV Providers in Vietnam to Learn: A Mixed-Methods Analysis of a Mobile Health Continuing Medical Education Intervention %A Larson Williams,Anna %A Hawkins,Andrew %A Sabin,Lora %A Halim,Nafisa %A Le Ngoc,Bao %A Nguyen,Viet Ha %A Nguyen,Tam %A Bonawitz,Rachael %A Gill,Christopher %+ Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd Floor, Boston, MA, 02118, United States, 1 617 638 5234, alarsonw@bu.edu %K continuing medical education %K HIV/AIDS %K mHealth %K Vietnam %K health education %K SMS intervention %K telemedicine %K text messaging %D 2019 %7 18.04.2019 %9 Original Paper %J JMIR Med Educ %G English %X Background: The Mobile Continuing Medical Education Project (mCME V.2.0) was a randomized controlled trial designed to test the efficacy of a text messaging (short message service [SMS])–based distance learning program in Vietnam that included daily quiz questions, links to readings and online courses, and performance feedback. The trial resulted in significant increases in self-study behaviors and higher examination scores for intervention versus control participants. Objective: The objective of this mixed-methods study was to conduct qualitative and quantitative investigations to understand participants’ views of the intervention. We also developed an explanatory framework for future trial replication. Methods: At the endline examination, all intervention participants completed a survey on their perspectives of mCME and self-study behaviors. We convened focus group discussions to assess their experiences with the intervention and attitudes toward continuing medical education. Results: A total of 48 HIV specialists in the intervention group completed the endline survey, and 30 participated in the focus group discussions. Survey and focus group data suggested that most clinicians liked the daily quizzes, citing them as convenient mechanisms to convey information in a relevant manner. A total of 43 of the 48 (90%) participants reported that the daily quizzes provided motivation to study for continuing medical education purposes. Additionally, 83% (40/48) of intervention participants expressed that they were better prepared to care for patients with HIV in their communities, compared with 67% (32/48) at baseline. Participation in the online coursework component was low (only 32/48, 67% of intervention participants ever accessed the courses), but most of those who did participate thought the lectures were engaging (26/32, 81%) and relevant (29/32, 91%). Focus group discussions revealed that various factors influenced the clinicians’ decision to engage in higher learning, or “lateral learning,” including the participant’s availability to study, professional relevance of the topic area, and feedback. These variables serve as modifying factors that fit within an adapted version of the health belief model, which can explain behavior change in this context. Conclusions: Qualitative and quantitative endline data suggested that mCME V.2.0 was highly acceptable. Participant behaviors during the trial fit within the health belief model and can explain the intervention’s impact on improving self-study behaviors. The mCME platform is an evidence-based approach with the potential for adoption at a national scale as a method for promoting continuing medical education. Trial Registration: ClinicalTrials.gov NCT02381743; https://clinicaltrials.gov/ct2/show/NCT02381743 %M 30998220 %R 10.2196/12058 %U http://mededu.jmir.org/2019/1/e12058/ %U https://doi.org/10.2196/12058 %U http://www.ncbi.nlm.nih.gov/pubmed/30998220 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 5 %N 1 %P e10982 %T Data Collection Approaches to Enable Evaluation of a Massive Open Online Course About Data Science for Continuing Education in Health Care: Case Study %A Alturkistani,Abrar %A Majeed,Azeem %A Car,Josip %A Brindley,David %A Wells,Glenn %A Meinert,Edward %+ Healthcare Translation Research Group, Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Oxford,, United Kingdom, 44 7824446808, edward.meinert@paediatrics.ox.ac.uk %K education, distance %K education %K teaching %K online learning %K online education %K MOOC %K massive open online course %D 2019 %7 02.04.2019 %9 Original Paper %J JMIR Med Educ %G English %X Background: This study presents learner perceptions of a pilot massive open online course (MOOC). Objective: The objective of this study was to explore data collection approaches to help inform future MOOC evaluations on the use of semistructured interviews and the Kirkpatrick evaluation model. Methods: A total of 191 learners joined 2 course runs of a limited trial of the MOOC. Moreover, 7 learners volunteered to be interviewed for the study. The study design drew on semistructured interviews of 2 learners transcribed and analyzed using Braun and Clark’s method for thematic coding. This limited participant set was used to identify how the Kirkpatrick evaluation model could be used to evaluate further implementations of the course at scale. Results: The study identified several themes that could be used for further analysis. The themes and subthemes include learner background (educational, professional, and topic significance), MOOC learning (learning achievement and MOOC application), and MOOC features (MOOC positives, MOOC negatives, and networking). There were insufficient data points to perform a Kirkpatrick evaluation. Conclusions: Semistructured interviews for MOOC evaluation can provide a valuable in-depth analysis of learners’ experience of the course. However, there must be sufficient data sources to complete a Kirkpatrick evaluation to provide for data triangulation. For example, data from precourse and postcourse surveys, quizzes, and test results could be used to improve the evaluation methodology. %M 30938683 %R 10.2196/10982 %U http://mededu.jmir.org/2019/1/e10982/ %U https://doi.org/10.2196/10982 %U http://www.ncbi.nlm.nih.gov/pubmed/30938683 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e11529 %T Clinical Virtual Simulation in Nursing Education: Randomized Controlled Trial %A Padilha,José Miguel %A Machado,Paulo Puga %A Ribeiro,Ana %A Ramos,José %A Costa,Patrício %+ Nursing School of Porto; CINTESIS – Tech4edusim, Street Dr António Bernardino de Almeida, Porto, 4200-072, Portugal, 351 225 073 500, miguelpadilha@esenf.pt %K clinical virtual simulation %K nursing education %K virtual patient %K user-computer interface %D 2019 %7 18.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: In the field of health care, knowledge and clinical reasoning are key with regard to quality and confidence in decision making. The development of knowledge and clinical reasoning is influenced not only by students’ intrinsic factors but also by extrinsic factors such as satisfaction with taught content, pedagogic resources and pedagogic methods, and the nature of the objectives and challenges proposed. Nowadays, professors play the role of learning facilitators rather than simple “lecturers” and face students as active learners who are capable of attributing individual meanings to their personal goals, challenges, and experiences to build their own knowledge over time. Innovations in health simulation technologies have led to clinical virtual simulation. Clinical virtual simulation is the recreation of reality depicted on a computer screen and involves real people operating simulated systems. It is a type of simulation that places people in a central role through their exercising of motor control skills, decision skills, and communication skills using virtual patients in a variety of clinical settings. Clinical virtual simulation can provide a pedagogical strategy and can act as a facilitator of knowledge retention, clinical reasoning, improved satisfaction with learning, and finally, improved self-efficacy. However, little is known about its effectiveness with regard to satisfaction, self-efficacy, knowledge retention, and clinical reasoning. Objective: This study aimed to evaluate the effect of clinical virtual simulation with regard to knowledge retention, clinical reasoning, self-efficacy, and satisfaction with the learning experience among nursing students. Methods: A randomized controlled trial with a pretest and 2 posttests was carried out with Portuguese nursing students (N=42). The participants, split into 2 groups, had a lesson with the same objectives and timing. The experimental group (n=21) used a case-based learning approach, with clinical virtual simulator as a resource, whereas the control group (n=21) used the same case-based learning approach, with recourse to a low-fidelity simulator and a realistic environment. The classes were conducted by the usual course lecturers. We assessed knowledge and clinical reasoning before the intervention, after the intervention, and 2 months later, with a true or false and multiple-choice knowledge test. The students’ levels of learning satisfaction and self-efficacy were assessed with a Likert scale after the intervention. Results: The experimental group made more significant improvements in knowledge after the intervention (P=.001; d=1.13) and 2 months later (P=.02; d=0.75), and it also showed higher levels of learning satisfaction (P<.001; d=1.33). We did not find statistical differences in self-efficacy perceptions (P=.9; d=0.054). Conclusions: The introduction of clinical virtual simulation in nursing education has the potential to improve knowledge retention and clinical reasoning in an initial stage and over time, and it increases the satisfaction with the learning experience among nursing students. %M 30882355 %R 10.2196/11529 %U http://www.jmir.org/2019/3/e11529/ %U https://doi.org/10.2196/11529 %U http://www.ncbi.nlm.nih.gov/pubmed/30882355 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e11123 %T Evaluation of an E-Learning Training Program to Support Implementation of a Group-Based, Theory-Driven, Self-Management Intervention For Osteoarthritis and Low-Back Pain: Pre-Post Study %A Hurley,Deirdre A %A Keogh,Alison %A Mc Ardle,Danielle %A Hall,Amanda M %A Richmond,Helen %A Guerin,Suzanne %A Magdalinski,Tara %A Matthews,James %+ School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, D4, Ireland, 353 17166524, deirdre.hurleyosing@ucd.ie %K technology-enhanced learning %K evaluation %K e-learning %K digital learning %K program evaluation %K effectiveness %K physiotherapy %K implementation %K osteoarthritis %K low-back pain %D 2019 %7 07.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: By adaptation of the face-to-face physiotherapist-training program previously used in the Self-management of Osteoarthritis and Low back pain through Activity and Skills (SOLAS) feasibility trial, an asynchronous, interactive, Web-based, e-learning training program (E-SOLAS) underpinned by behavior and learning theories was developed. Objective: This study investigated the effect of the E-SOLAS training program on relevant outcomes of effective training and implementation. Methods: Thirteen physiotherapists from across Ireland were trained via E-SOLAS by using mixed methods, and seven physiotherapists progressed to implementation of the 6-week group-based SOLAS intervention. The effectiveness of E-SOLAS was evaluated using the Kirkpatrick model at the levels of reaction (physiotherapist engagement and satisfaction with E-SOLAS training methods and content), learning (pre- to posttraining changes in physiotherapists’ confidence and knowledge in delivering SOLAS content and self-determination theory-based communication strategies, administered via a SurveyMonkey questionnaire), and behavior (fidelity to delivery of SOLAS content using physiotherapist-completed weekly checklists). During implementation, five physiotherapists audio recorded delivery of one class, and the communication between physiotherapists and clients was assessed using the Health Care Climate Questionnaire (HCCQ), the Controlling Coach Behaviour Scale (CCBS), and an intervention-specific measure (ISM; 7-point Likert scale). A range of implementation outcomes were evaluated during training and delivery (ie, acceptability, appropriateness, feasibility, fidelity, and sustainability of E-SOLAS) using a posttraining feedback questionnaire and individual semistructured telephone interviews. Results: With regard to their reaction, physiotherapists (n=13) were very satisfied with E-SOLAS posttraining (median 5.0; interquartile range 1.0; min-max 4.0-5.0) and completed training within 3-4 weeks. With regard to learning, there were significant increases in physiotherapists’ confidence and knowledge in delivery of all SOLAS intervention components (P<.05). Physiotherapists’ confidence in 7 of 10 self-determination theory-based communication strategies increased (P<.05), whereas physiotherapists’ knowledge of self-determination theory-based strategies remained high posttraining (P>.05). In terms of behavior, physiotherapists delivered SOLAS in a needs supportive manner (HCCQ: median 5.2, interquartile range 1.3, min-max 3.7-5.8; CCBS: median 6.6, interquartile range 1.0, min-max 5.6-7.0; ISM: median 4.5, interquartile range 1.2, min-max 2.8-4.8). Fidelity scores were high for SOLAS content delivery (total %mean fidelity score 93.5%; SD 4.9%). The posttraining questionnaire and postdelivery qualitative interviews showed that physiotherapists found E-SOLAS acceptable, appropriate, feasible, and sustainable within primary care services to support the implementation of the SOLAS intervention. Conclusions: This study provides preliminary evidence of the effectiveness, acceptability, and feasibility of an e-learning program to train physiotherapists to deliver a group-based self-management complex intervention in primary care settings, which is equivalent to face-to-face training outcomes and would support inclusion of physiotherapists in a definitive trial of SOLAS. %M 30843863 %R 10.2196/11123 %U https://www.jmir.org/2019/3/e11123/ %U https://doi.org/10.2196/11123 %U http://www.ncbi.nlm.nih.gov/pubmed/30843863 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e12997 %T Digital Health Professions Education on Diabetes Management: Systematic Review by the Digital Health Education Collaboration %A Huang,Zhilian %A Semwal,Monika %A Lee,Shuen Yee %A Tee,Mervin %A Ong,William %A Tan,Woan Shin %A Bajpai,Ram %A Tudor Car,Lorainne %+ Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Level 18, Clinical Sciences Building, Singapore, 308232, Singapore, 65 69041258, lorainne.tudor.car@ntu.edu.sg %K evidence-based practice %K health personnel %K learning %K systematic review %K diabetes mellitus %D 2019 %7 21.02.2019 %9 Review %J J Med Internet Res %G English %X Background: There is a shortage of health care professionals competent in diabetes management worldwide. Digital education is increasingly used in educating health professionals on diabetes. Digital diabetes self-management education for patients has been shown to improve patients’ knowledge and outcomes. However, the effectiveness of digital education on diabetes management for health care professionals is still unknown. Objective: The objective of this study was to assess the effectiveness and economic impact of digital education in improving health care professionals’ knowledge, skills, attitudes, satisfaction, and competencies. We also assessed its impact on patient outcomes and health care professionals’ behavior. Methods: We included randomized controlled trials evaluating the impact of digitalized diabetes management education for health care professionals pre- and postregistration. Publications from 1990 to 2017 were searched in MEDLINE, EMBASE, Cochrane Library, PsycINFO, CINAHL, ERIC, and Web of Science. Screening, data extraction and risk of bias assessment were conducted independently by 2 authors. Results: A total of 12 studies met the inclusion criteria. Studies were heterogeneous in terms of digital education modality, comparators, outcome measures, and intervention duration. Most studies comparing digital or blended education to traditional education reported significantly higher knowledge and skills scores in the intervention group. There was little or no between-group difference in patient outcomes or economic impact. Most studies were judged at a high or unclear risk of bias. Conclusions: Digital education seems to be more effective than traditional education in improving diabetes management–related knowledge and skills. The paucity and low quality of the available evidence call for urgent and well-designed studies focusing on important outcomes such as health care professionals’ behavior, patient outcomes, and cost-effectiveness as well as its impact in diverse settings, including developing countries. %M 30789348 %R 10.2196/12997 %U http://www.jmir.org/2019/2/e12997/ %U https://doi.org/10.2196/12997 %U http://www.ncbi.nlm.nih.gov/pubmed/30789348 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 4 %N 2 %P e10222 %T How Self-Directed e-Learning Contributes to Training for Medical Licentiate Practitioners in Zambia: Evaluation of the Pilot Phase of a Mixed-Methods Study %A Barteit,Sandra %A Jahn,Albrecht %A Bowa,Annel %A Lüders,Sigrid %A Malunga,Gregory %A Marimo,Clemence %A Wolter,Sigrid %A Neuhann,Florian %+ Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 62215634030, barteit@uni-heidelberg.de %K evaluation %K medical e-learning %K intervention %K sustainability %K effectiveness %K adoption %K health care workers %K rural health %K sub-Saharan Africa %D 2018 %7 27.11.2018 %9 Original Paper %J JMIR Med Educ %G English %X 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. %M 30482744 %R 10.2196/10222 %U http://mededu.jmir.org/2018/2/e10222/ %U https://doi.org/10.2196/10222 %U http://www.ncbi.nlm.nih.gov/pubmed/30482744 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e10396 %T Effectiveness of the Malnutrition eLearning Course for Global Capacity Building in the Management of Malnutrition: Cross-Country Interrupted Time-Series Study %A Choi,Sunhea %A Yuen,Ho Ming %A Annan,Reginald %A Pickup,Trevor %A Pulman,Andy %A Monroy-Valle,Michele %A Aduku,Nana Esi Linda %A Kyei-Boateng,Samuel %A Velásquez Monzón,Carmen Isabel %A Portillo Sermeño,Carmen Elisa %A Penn,Andrew %A Ashworth,Ann %A Jackson,Alan A %+ Human Development and Health, Faculty of Medicine, University of Southampton, Mailpoint 820, Level B, South Academic Block, Southampton General Hospital, Southampton, SO16 6YD, United Kingdom, 44 23 8120 4330, s.choi@southampton.ac.uk %K eLearning %K severe acute malnutrition %K WHO guidelines for malnutrition %K capacity building %K staff development %K quality improvement %K nutrition training and education %D 2018 %7 03.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Scaling up improved management of severe acute malnutrition has been identified as the nutrition intervention with the largest potential to reduce child mortality, but lack of operational capacity at all levels of the health system constrains scale-up. We therefore developed an interactive malnutrition eLearning course that is accessible at scale to build capacity of the health sector workforce to manage severely malnourished children according to the guidelines of the World Health Organization. Objective: The aim of this study was to test whether the malnutrition eLearning course improves knowledge and skills of in-service and preservice health professionals in managing children with severe acute malnutrition and enables them to apply the gained knowledge and skills in patient care. Methods: This 2-year prospective, longitudinal, cross-country, interrupted time-series study took place in Ghana, Guatemala, El Salvador, and Colombia between January 2015 and February 2017. A subset of 354 in-service health personnel from 12 hospitals and 2 Ministries of Health, 703 preservice trainees from 9 academic institutions, and 204 online users participated. Knowledge gained after training and retention over time was measured through pre- and postassessments comprising questions pertaining to screening, diagnosis, pathophysiology and treatment, and prevention of malnutrition. Comprehension, application, and integration of knowledge were tested. Changes in perception, confidence, and clinical practice were assessed through questionnaires and interviews. Results: Before the course, awareness of the World Health Organization guidelines was 36.73% (389/1059) overall, and 26.3% (94/358) among in-service professionals. The mean score gain in knowledge after access to the course in 606 participants who had pre- and postassessment data was 11.8 (95% CI 10.8-12.9; P<.001)—a relative increase of 41.5%. The proportion of participants who achieved a score above the pass mark posttraining was 58.7% (356/606), compared with 18.2% (110/606) in pretraining. Of the in-service professionals, 85.9% (128/149) reported applying their knowledge by changing their clinical practice in screening, assessment, diagnosis, and management. This group demonstrated significantly increased retained knowledge 6 months after training (mean difference [SD] from preassessment of 12.1 [11.8]), retaining 65.8% (12.1/18.4) of gained knowledge from the training. Changes in the management of malnutrition were reported by trained participants, and institutional, operational, and policy changes were also found. Conclusions: The malnutrition eLearning course improved knowledge, understanding, and skills of health professionals in the diagnosis and management of children with severe acute malnutrition, and changes in clinical practice and confidence were reported following the completion of the course. %R 10.2196/10396 %U http://www.jmir.org/2018/10/e10396/ %U https://doi.org/10.2196/10396 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e193 %T The Effectiveness of a Computer-Tailored E-Learning Program for Practice Nurses to Improve Their Adherence to Smoking Cessation Counseling Guidelines: Randomized Controlled Trial %A de Ruijter,Dennis %A Candel,Math %A Smit,Eline Suzanne %A de Vries,Hein %A Hoving,Ciska %+ Care and Public Health Research Institute, Department of Health Promotion, Maastricht University, , Maastricht,, Netherlands, 31 43 388 24 06, d.deruijter@maastrichtuniversity.nl %K online learning %K guideline adherence %K advanced practice nursing %K randomized controlled trial %K smoking cessation %D 2018 %7 22.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Improving practice nurses’ (PN) adherence to smoking cessation counseling guidelines will benefit the quality of smoking cessation care and will potentially lead to higher smoking abstinence rates. However, support programs to aid PNs in improving their guideline uptake and adherence do not exist yet. Objective: The aim of this study was to assess the effects of a novel computer-tailored electronic learning (e-learning) program on PNs’ smoking cessation guideline adherence. Methods: A Web-based randomized controlled trial (RCT) was conducted in which an intervention group (N=147) with full access to the e-learning program for 6 months was compared with a control group (N=122) without access. Data collection was fully automated at baseline and 6-month follow-up via online questionnaires, assessing PNs’ demographics, work-related factors, potential behavioral predictors based on the I-Change model, and guideline adherence. PNs also completed counseling checklists to retrieve self-reported counseling activities for each consultation with a smoker (N=1175). To assess the program’s effectiveness in improving PNs’ guideline adherence (ie, overall adherence and adherence to individual counseling guideline steps), mixed linear and logistic regression analyses were conducted, thus accommodating for the smokers being nested within PNs. Potential effect moderation by work-related factors and behavioral predictors was also examined. Results: After 6 months, 121 PNs in the intervention group (82.3%, 121/147) and 103 in the control group (84.4%, 103/122) completed the follow-up questionnaire. Mixed linear regression analysis revealed that counseling experience moderated the program’s effect on PNs’ overall guideline adherence (beta=.589; 95% CI 0.111-1.068; PHolm-Bonferroni =.048), indicating a positive program effect on adherence for PNs with a more than average level of counseling experience. Mixed logistic regression analyses regarding adherence to individual guideline steps revealed a trend toward moderating effects of baseline levels of behavioral predictors and counseling experience. More specifically, for PNs with less favorable scores on behavioral predictors (eg, low baseline self-efficacy) and high levels of counseling experience, the program significantly increased adherence. Conclusions: Results from our RCT showed that among PNs with more than average counseling experience, the e-learning program resulted in significantly better smoking cessation guideline adherence. Experienced PNs might have been better able to translate the content of our e-learning program into practically applicable counseling strategies compared with less experienced colleagues. Less favorable baseline levels of behavioral predictors among PNs possibly contributed to this effect, as there was more room for improvement by consulting the tailored content of the e-learning program. To further substantiate the effectiveness of e-learning programs on guideline adherence by health care professionals (HCPs), it is important to assess how to support a wider range of HCPs. Trial Registration: Netherlands Trial Register NTR4436; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4436 (Archived by WebCite at http://www.webcitation.org/6zJQuSRq0) %M 29789278 %R 10.2196/jmir.9276 %U http://www.jmir.org/2018/5/e193/ %U https://doi.org/10.2196/jmir.9276 %U http://www.ncbi.nlm.nih.gov/pubmed/29789278 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 4 %N 1 %P e5 %T Evaluating the Effect of a Web-Based E-Learning Tool for Health Professional Education on Clinical Vancomycin Use: Comparative Study %A Bond,Stuart Evan %A Crowther,Shelley P %A Adhikari,Suman %A Chubaty,Adriana J %A Yu,Ping %A Borchard,Jay P %A Boutlis,Craig Steven %A Yeo,Wilfred Winston %A Miyakis,Spiros %+ Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Aberford Rd, Wakefield, WF14DG, United Kingdom, 44 01924317043, stuart.bond@nhs.net %K nursing education %K pharmacy education %K medical education %K continuing education %K survey methods %K antibacterial agents %D 2018 %7 26.02.2018 %9 Original Paper %J JMIR Med Educ %G English %X Background: Internet-based learning for health professional education is increasing. It offers advantages over traditional learning approaches, as it enables learning to be completed at a time convenient to the user and improves access where facilities are geographically disparate. We developed and implemented the Vancomycin Interactive (VI) e-learning tool to improve knowledge on the clinical use of the antibiotic vancomycin, which is commonly used for treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Objective: The aims of this study were to evaluate the effect of the VI e-learning tool on (1) survey knowledge scores and (2) clinical use of vancomycin among health professionals. Methods: We conducted a comparative pre-post intervention study across the 14 hospitals of two health districts in New South Wales, Australia. A knowledge survey was completed by nurses, doctors, and pharmacists before and after release of a Web-based e-learning tool. Survey scores were compared with those obtained following traditional education in the form of an email intervention. Survey questions related to dosing, administration, and monitoring of vancomycin. Outcome measures were survey knowledge scores among the three health professional groups, vancomycin plasma trough levels, and vancomycin approvals recorded on a computerized clinical decision support system. Results: Survey response rates were low at 26.87% (577/2147) preintervention and 8.24% (177/2147) postintervention. The VI was associated with an increase in knowledge scores (maximum score=5) among nurses (median 2, IQR 1-2 to median 2, IQR 1-3; P<.001), but not among other professional groups. The comparator email intervention was associated with an increase in knowledge scores among doctors (median 3, IQR 2-4 to median 4, IQR 2-4; P=.04). Participants who referred to Web-based resources while completing the e-learning tool achieved higher overall scores than those who did not (P<.001). The e-learning tool was not shown to be significantly more effective than the comparator email in the clinical use of vancomycin, as measured by plasma levels within the therapeutic range. Conclusions: The e-learning tool was associated with improved knowledge scores among nurses, whereas the comparator email was associated with improved scores among doctors. This implies that different strategies may be required for optimizing the effectiveness of education among different health professional groups. Low survey response rates limited conclusions regarding the tool’s effectiveness. Improvements to design and evaluation methodology may increase the likelihood of a demonstrable effect from e-learning tools in the future. %M 29483071 %R 10.2196/mededu.7719 %U http://mededu.jmir.org/2018/1/e5/ %U https://doi.org/10.2196/mededu.7719 %U http://www.ncbi.nlm.nih.gov/pubmed/29483071 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 4 %N 1 %P e2 %T A Web-Based Course on Public Health Principles in Disaster and Medical Humanitarian Response: Survey Among Students and Faculty %A Tam,Greta %A Chan,Emily Ying Yang %A Liu,Sida %+ Collaborating Centre for Oxford University and Chinese University of Hong Kong for Disaster and Medical Humanitarian Response, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 308, 3rd Floor, Prince of Wales Hospital, 30-32 Ngan Shing St, Sha Tin, Hong Kong,, China (Hong Kong), 852 22528411, emily.chan@cuhk.edu.hk %K disaster planning %K online education %K Donabedian model %K public health %D 2018 %7 26.01.2018 %9 Original Paper %J JMIR Med Educ %G English %X Background: Web-based public health courses are becoming increasingly popular. “Public Health Principles in Disaster and Medical Humanitarian Response” is a unique Web-based course in Hong Kong. This course aimed to fill a public health training gap by reaching out to postgraduates who are unable to access face-to-face learning. Objective: The aim of this paper was to use a structured framework to objectively evaluate the effectiveness of a Web-based course according to Greenhalgh et al’s quality framework and the Donabedian model to make recommendations for program improvement. Methods: An interim evaluation of the first cohort of students in 2014 was conducted according to the Donabedian model and a quality framework by Greenhalgh et al using objective and self-reported data. Results: Students who registered for the first cohort (n=1152) from June 16, 2014 to December 15, 2014 (6 months) were surveyed. Two tutors and the course director were interviewed. The Web-based course was effective in using technology to deliver suitable course materials and assessment and to enhance student communication, support, and learning. Of the total number of students registered, 59.00% (680/1152) were nonlocal, originating from 6 continents, and 72.50% (835/1152) possessed a bachelor’s or postgraduate degree. The completion rate was 20.00% (230/1152). The chi-square test comparing students who completed the course with dropouts showed no significant difference in gender (P=.40), age (P=.98), occupation (P=.43), or qualification (P=.17). The cost (HK $272 per student) was lower than that of conducting a face-to-face course (HK $4000 per student). Conclusions: The Web-based course was effective in using technology to deliver a suitable course and reaching an intended audience. It had a higher completion rate than other Web-based courses. However, sustainable sources of funding may be needed to maintain the free Web-based course. %M 29374007 %R 10.2196/mededu.8495 %U http://mededu.jmir.org/2018/1/e2/ %U https://doi.org/10.2196/mededu.8495 %U http://www.ncbi.nlm.nih.gov/pubmed/29374007 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 1 %P e19 %T Integrated Decentralized Training for Health Professions Education at the University of KwaZulu-Natal, South Africa: Protocol for the I-DecT Project %A Govender,Pragashnie %A Chetty,Verusia %A Naidoo,Deshini %A Pefile,Ntsikelelo %+ College of Health Sciences, University of KwaZulu-Natal, Private Bag x54001, Durban,, South Africa, 27 312608258, naidoopg@ukzn.ac.za %K decentralized clinical training, health science, South Africa, health care %D 2018 %7 25.01.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: The Integrated Decentralized Training (i-DecT) project was created to address the current need for health care in South Africa among resource poor climates in rural and periurban settings. The University of KwaZulu-Natal (UKZN) in South Africa has embarked on a program within the School of Health Sciences (SHS) to decentralize the clinical learning platform in order to address this disparity. Framed in a pragmatic stance, this proposal is geared towards informing the roll out of decentralized clinical training (DCT) within the province of KwaZulu-Natal. There currently remains uncertainty as to how the implementation of this program will unfold, especially for the diverse SHS, which includes specialities like audiology, dentistry, occupational therapy, optometry, pharmacy, physiotherapy, speech-language pathology, and sport science. Consequently, there is a need to carefully monitor and manage this DCT in order to ensure that the participating students have a positive learning experience and achieve expected academic outcomes, and that the needs of the communities are addressed adequately. Objective: The study aims to explore the factors that will influence the roll-out of the DCT by developing an inclusive and context-specific model that will adhere to the standards set by the SHS for the DCT program at UKZN. Methods: Key role players, including but not limited to, the South African Ministry of Health policy makers, clinicians, policy makers at UKZN, clinical educators, academicians, and students of UKZN within the SHS will participate in this project. Once the infrastructural, staffing and pedagogical enablers and challenges are identified, together with a review of existing models of decentralized training, a context-specific model for DCTl will be proposed based on initial pilot data that will be tested within iterative cycles in an Action Learning Action Research (ALAR) process. Results: The study was designed to fit within the existing structures, and emerging framework and memorandum of understanding between the partners of this initiative, namely, the Ministry of Health and UKZN in order to develop health care professionals that are competent and prepared for the changing dynamics of healthcare in a developing world. Conclusions: It is envisioned that this study, the first to include a combination of health professionals in a DCT platform at UKZN, will not only contribute to effective service delivery, but may also serve to promote an interprofessional cooperation within the SHS and tertiary institutions in similar settings. %M 29371175 %R 10.2196/resprot.7551 %U http://www.researchprotocols.org/2018/1/e19/ %U https://doi.org/10.2196/resprot.7551 %U http://www.ncbi.nlm.nih.gov/pubmed/29371175 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 12 %P e411 %T A Web-Based Training Resource for Therapists to Deliver an Evidence-Based Exercise Program for Rheumatoid Arthritis of the Hand (iSARAH): Design, Development, and Usability Testing %A Srikesavan,Cynthia Swarnalatha %A Williamson,Esther %A Eldridge,Lucy %A Heine,Peter %A Adams,Jo %A Cranston,Tim %A Lamb,Sarah E %+ Centre for Rehabilitation Research in Oxford, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, United Kingdom, 44 01865 737907, cynthia.srikesavan@ndorms.ox.ac.uk %K hand function %K hand exercises %K rheumatoid arthritis %K online training %K implementation %D 2017 %7 13.12.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) is a tailored, progressive exercise program for people having difficulties with wrist and hand function due to rheumatoid arthritis (RA). The program was evaluated in a large-scale clinical trial and was found to improve hand function, was safe to deliver, and was cost-effective. These findings led to the SARAH program being recommended in the UK National Institute for Health and Care Excellence guidelines for the management of adults with RA. To facilitate the uptake of this evidence-based program by clinicians, we proposed a Web-based training program for SARAH (iSARAH) to educate and train physiotherapists and occupational therapists on delivering the SARAH program in their practice. The overall iSARAH implementation project was guided by the 5 phases of the analysis, design, development, implementation, and evaluation (ADDIE) system design model. Objective: The objective of our study was to conduct the first 3 phases of the model in the development of the iSARAH project. Methods: Following publication of the trial, the SARAH program materials were made available to therapists to download from the trial website for use in clinical practice. A total of 35 therapists who downloaded these materials completed an online survey to provide feedback on practice trends in prescribing hand exercises for people with RA, perceived barriers and facilitators to using the SARAH program in clinical practice, and their preferences for the content and Web features of iSARAH. The development and design of iSARAH were further guided by a team of multidisciplinary health professionals (n=17) who took part in a half-day development meeting. We developed the preliminary version of iSARAH and tested it among therapists (n=10) to identify and rectify usability issues and to produce the final version. Results: The major recommendations made by therapists and the multidisciplinary team were having a simple Web design and layout, clear exercise pictures and videos, and compatibility of iSARAH on various browsers and devices. We rectified all usability issues in the preliminary version to develop the final version of iSARAH, which included 4 short modules and additional sections on self-assessment, frequently asked questions, and a resource library. Conclusions: The use of the ADDIE design model and engagement of end users in the development and evaluation phases have rendered iSARAH a convenient, easy-to-use, and effective Web-based learning resource for therapists on how to deliver the SARAH program. There is also huge potential for adapting iSARAH across different cultures and languages, thus opening more opportunities for wider uptake and application of the SARAH program into practice. %M 29237581 %R 10.2196/jmir.8424 %U http://www.jmir.org/2017/12/e411/ %U https://doi.org/10.2196/jmir.8424 %U http://www.ncbi.nlm.nih.gov/pubmed/29237581 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e214 %T Scaling Up Psychological Treatments: A Countrywide Test of the Online Training of Therapists %A Fairburn,Christopher G %A Allen,Elizabeth %A Bailey-Straebler,Suzanne %A O'Connor,Marianne E %A Cooper,Zafra %+ Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford,, United Kingdom, 44 186 561 3199, credo@medsci.ox.ac.uk %K psychotherapy %K training %K dissemination %K Internet %K eating disorders %K cognitive behavior therapy %D 2017 %7 16.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: A major barrier to the widespread dissemination of psychological treatments is the way that therapists are trained. The current method is not scalable. Objective: Our objective was to conduct a proof-of-concept study of Web-centered training, a scalable online method for training therapists. Methods: The Irish Health Service Executive identified mental health professionals across the country whom it wanted to be trained in a specific psychological treatment for eating disorders. These therapists were given access to a Web-centered training program in transdiagnostic cognitive behavior therapy for eating disorders. The training was accompanied by a scalable form of support consisting of brief encouraging telephone calls from a nonspecialist. The trainee therapists completed a validated measure of therapist competence before and after the training. Results: Of 102 therapists who embarked upon the training program, 86 (84.3%) completed it. There was a substantial increase in their competence scores following the training (mean difference 5.84, 95% Cl –6.62 to –5.05; P<.001) with 42.5% (34/80) scoring above a predetermined cut-point indicative of a good level of competence. Conclusions: Web-centered training proved feasible and acceptable and resulted in a marked increase in therapist competence scores. If these findings are replicated, Web-centered training would provide a means of simultaneously training large numbers of geographically dispersed trainees at low cost, thereby overcoming a major obstacle to the widespread dissemination of psychological treatments. %M 28623184 %R 10.2196/jmir.7864 %U http://www.jmir.org/2017/6/e214/ %U https://doi.org/10.2196/jmir.7864 %U http://www.ncbi.nlm.nih.gov/pubmed/28623184 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e203 %T The Second Victim Phenomenon After a Clinical Error: The Design and Evaluation of a Website to Reduce Caregivers’ Emotional Responses After a Clinical Error %A Mira,José Joaquín %A Carrillo,Irene %A Guilabert,Mercedes %A Lorenzo,Susana %A Pérez-Pérez,Pastora %A Silvestre,Carmen %A Ferrús,Lena %A , %+ Alicante-Sant Joan Health District, Universidad Miguel Hernández, Avenue Universidad s/n, Elche (Alicante), 03202, Spain, 34 606433599, jose.mira@umh.es %K patient safety %K professionals %K hospital %K primary care %K second victims %K clinical error %K e-learning %D 2017 %7 08.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Adverse events (incidents that harm a patient) can also produce emotional hardship for the professionals involved (second victims). Although a few international pioneering programs exist that aim to facilitate the recovery of the second victim, there are no known initiatives that aim to raise awareness in the professional community about this issue and prevent the situation from worsening. Objective: The aim of this study was to design and evaluate an online program directed at frontline hospital and primary care health professionals that raises awareness and provides information about the second victim phenomenon. Methods: The design of the Mitigating Impact in Second Victims (MISE) online program was based on a literature review, and its contents were selected by a group of 15 experts on patient safety with experience in both clinical and academic settings. The website hosting MISE was subjected to an accreditation process by an external quality agency that specializes in evaluating health websites. The MISE structure and content were evaluated by 26 patient safety managers at hospitals and within primary care in addition to 266 frontline health care professionals who followed the program, taking into account its comprehension, usefulness of the information, and general adequacy. Finally, the amount of knowledge gained from the program was assessed with three objective measures (pre- and posttest design). Results: The website earned Advanced Accreditation for health websites after fulfilling required standards. The comprehension and practical value of the MISE content were positively assessed by 88% (23/26) and 92% (24/26) of patient safety managers, respectively. MISE was positively evaluated by health care professionals, who awarded it 8.8 points out of a maximum 10. Users who finished MISE improved their knowledge on patient safety terminology, prevalence and impact of adverse events and clinical errors, second victim support models, and recommended actions following a severe adverse event (P<.001). Conclusions: The MISE program differs from existing intervention initiatives by its preventive nature in relation to the second victim phenomenon. Its online nature makes it an easily accessible tool for the professional community. This program has shown to increase user’s knowledge on this issue and it helps them correct their approach. Furthermore, it is one of the first initiatives to attempt to bring the second victim phenomenon closer to primary care. %M 28596148 %R 10.2196/jmir.7840 %U http://www.jmir.org/2017/6/e203/ %U https://doi.org/10.2196/jmir.7840 %U http://www.ncbi.nlm.nih.gov/pubmed/28596148 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 3 %N 1 %P e8 %T Simulation Training: Evaluating the Instructor’s Contribution to a Wizard of Oz Simulator in Obstetrics and Gynecology Ultrasound Training %A Katz,Aric %A Tepper,Ronnie %A Shtub,Avraham %+ Technion - Israel Institute of Technology, Industrial Engineering & Management, Technion, Technion City, Haifa, 3200003, Israel, 972 972 4 8294402, shtub@ie.technion.ac.il %K distance learning %K feedback %K simulation training %K evaluation research %D 2017 %7 21.04.2017 %9 Original Paper %J JMIR Med Educ %G English %X Background: Workplaces today demand graduates who are prepared with field-specific knowledge, advanced social skills, problem-solving skills, and integration capabilities. Meeting these goals with didactic learning (DL) is becoming increasingly difficult. Enhanced training methods that would better prepare tomorrow’s graduates must be more engaging and game-like, such as feedback based e-learning or simulation-based training, while saving time. Empirical evidence regarding the effectiveness of advanced learning methods is lacking. Objective quantitative research comparing advanced training methods with DL is sparse. Objectives: This quantitative study assessed the effectiveness of a computerized interactive simulator coupled with an instructor who monitored students’ progress and provided Web-based immediate feedback. Methods: A low-cost, globally accessible, telemedicine simulator, developed at the Technion—Israel Institute of Technology, Haifa, Israel—was used. A previous study in the field of interventional cardiology, evaluating the efficacy of the simulator to enhanced learning via knowledge exams, presented promising results of average scores varying from 94% after training and 54% before training (n=20) with P<.001. Two independent experiments involving obstetrics and gynecology (Ob-Gyn) physicians and senior ultrasound sonographers, with 32 subjects, were conducted using a new interactive concept of the WOZ (Wizard of OZ) simulator platform. The contribution of an instructor to learning outcomes was evaluated by comparing students’ knowledge before and after each interactive instructor-led session as well as after fully automated e-learning in the field of Ob-Gyn. Results from objective knowledge tests were analyzed using hypothesis testing and model fitting. Results: A significant advantage (P=.01) was found in favor of the WOZ training approach. Content type and training audience were not significant. Conclusions: This study evaluated the contribution of an integrated teaching environment using a computerized interactive simulator, with an instructor providing immediate Web-based immediate feedback to trainees. Involvement of an instructor in the simulation-based training process provided better learning outcomes that varied training content and trainee populations did not affect the overall learning gains. %M 28432039 %R 10.2196/mededu.6312 %U http://mededu.jmir.org/2017/1/e8/ %U https://doi.org/10.2196/mededu.6312 %U http://www.ncbi.nlm.nih.gov/pubmed/28432039 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 3 %N 1 %P e6 %T The Coags Uncomplicated App: Fulfilling Educational Gaps Around Diagnosis and Laboratory Testing of Coagulation Disorders %A Kessler,Craig %A Peerschke,Ellinor I %A Chitlur,Meera B %A Kulkarni,Roshni %A Holot,Natalia %A Cooper,David L %+ Georgetown University Medical Center, Lombardi Cancer Center, Podium A, 3700 Reservoir Road, NW, Washington, DC, 20007, United States, 1 (202) 444 8676, KESSLERC@gunet.georgetown.edu %K blood coagulation disorders %K smartphone %K diagnosis %K hematology %K differential diagnosis %D 2017 %7 18.04.2017 %9 Original Paper %J JMIR Med Educ %G English %X Background: Patients with coagulation disorders may present to a variety of physician specialties; however, accurate and efficient diagnosis can be challenging for physicians not specialized in hematology, due to identified gaps in knowledge around appropriate laboratory assays and interpretation of test results. Coags Uncomplicated was developed to fill this unmet educational need by increasing practical knowledge of coagulation disorders among nonexpert physicians and other health care professionals (HCPs) in a point-of-care (POC) setting. Objective: The aim of this study was to assess patterns of use of the mobile app Coags Uncomplicated, a tool designed to support education regarding accurate and efficient diagnosis of bleeding disorders. Methods: App metrics were obtained by tracking registered user data. Additionally, a survey was distributed to registered users, to assess circumstances and frequency of use. Results: The most common specialties of 7596 registered US users were hematology-oncology (n=1534, 20.19%), hematology (n=1014, 13.35%), and emergency medicine (n=1222, 16.09%); most identified as physicians (n=4082, 53.74%). Specialties accounting for the greatest numbers of screen views were hematology-oncology (99,390 views), hematology (47,808 views), emergency medicine (23,121 views), and internal medicine (22,586 views). The most common diagnostic endpoints reached were disseminated intravascular coagulation (DIC; 2713 times), liver disease effect (2108 times), and vitamin K deficiency (1584 times). Of 3424 users asked to take the survey, 262 responded (7.65%); most were physicians in direct clinical care (71%) and specialized in hematology-oncology (39%) or emergency medicine (21%). Most frequent use was reported by hematologists (69%, ≥6 times) and hematologists-oncologists (38%, ≥6 times). Most physicians (89.2%) reported using the app for patient-case-related education around appropriate use of laboratory tests in diagnostic evaluation. Physicians rated Lab Value Analyzer (mean 4.43) and Lab Test Algorithm (mean 4.46) tools highly on a 5-point “how helpful” scale and were likely to recommend the app to colleagues. Conclusions: App use among physicians and other HCPs is consistent with value as a POC educational tool, which may facilitate differential diagnoses and appropriate early consultation with hematologists. %M 28420603 %R 10.2196/mededu.6858 %U http://mededu.jmir.org/2017/1/e6/ %U https://doi.org/10.2196/mededu.6858 %U http://www.ncbi.nlm.nih.gov/pubmed/28420603 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 5 %N 1 %P e1 %T Development of an Educational Game to Set Up Surgical Instruments on the Mayo Stand or Back Table: Applied Research in Production Technology %A Paim,Crislaine Pires Padilha %A Goldmeier,Silvia %+ Institute of Cardiology of Rio Grande do Sul, University Foundation of Cardiology, 395 Princesa Isabel Avenue, Porto Alegre, 90620-001, Brazil, 55 51 32303600, sgoldmeier@gmail.com %K nursing education research %K educational technology %K perioperative nursing %D 2017 %7 10.01.2017 %9 Original Paper %J JMIR Serious Games %G English %X Background: Existing research suggests that digital games can be used effectively for educational purposes at any level of training. Perioperative nursing educators can use games to complement curricula, in guidance and staff development programs, to foster team collaboration, and to give support to critical thinking in nursing practice because it is a complex environment. Objective: To describe the process of developing an educational game to set up surgical instruments on the Mayo stand or back table as a resource to assist the instructor in surgical instrumentation training for students and nursing health professionals in continued education. Methods: The study was characterized by applied research in production technology. It included the phases of analysis and design, development, and evaluation. The objectives of the educational game were developed through Bloom’s taxonomy. Parallel to the physical development of the educational game, a proposed model for the use of digital elements in educational game activities was applied to develop the game content. Results: The development of the game called “Playing with Tweezers” was carried out in 3 phases and was evaluated by 15 participants, comprising students and professional experts in various areas of knowledge such as nursing, information technology, and education. An environment was created with an initial screen, menu buttons containing the rules of the game, and virtual tour modes for learning and assessment. Conclusions: The “digital” nursing student needs engagement, stimulation, reality, and entertainment, not just readings. “Playing with Tweezers” is an example of educational gaming as an innovative teaching strategy in nursing that encourages the strategy of involving the use of educational games to support theoretical or practical classroom teaching. Thus, the teacher does not work with only 1 type of teaching methodology, but with a combination of different methodologies. In addition, we cannot forget that skill training in an educational game does not replace curricular practice, but helps. %M 28073736 %R 10.2196/games.6048 %U http://games.jmir.org/2017/1/e1/ %U https://doi.org/10.2196/games.6048 %U http://www.ncbi.nlm.nih.gov/pubmed/28073736 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 1 %P e2 %T Online Tobacco Cessation Training and Competency Assessment for Complementary and Alternative Medicine (CAM) Practitioners: Protocol for the CAM Reach Web Study %A Muramoto,Myra L %A Howerter,Amy %A Eaves,Emery R %A Hall,John R %A Buller,David B %A Gordon,Judith S %+ University of Arizona, Department of Family & Community Medicine, 1450 N Cherry Ave, Tucson, AZ, 85719, United States, 1 520 626 1090, myram@email.arizona.edu %K tobacco cessation %K brief intervention %K online training %K communication %K acupuncture %K chiropractic %K massage therapy %D 2016 %7 06.01.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Complementary and alternative medicine (CAM) practitioners, such as chiropractors, acupuncturists, and massage therapists, are a growing presence in the US health care landscape and already provide health and wellness care to significant numbers of patients who use tobacco. For decades, conventional biomedical practitioners have received training to provide evidence-based tobacco cessation brief interventions (BIs) and referrals to cessation services as part of routine clinical care, whereas CAM practitioners have been largely overlooked for BI training. Web-based training has clear potential to meet large-scale training dissemination needs. However, despite the exploding use of Web-based training for health professionals, Web-based evaluation of clinical skills competency remains underdeveloped. Objective: In pursuit of a long-term goal of helping CAM practitioners integrate evidence-based practices from US Public Health Service Tobacco Dependence Treatment Guideline into routine clinical care, this pilot protocol aims to develop and test a Web-based tobacco cessation training program tailored for CAM practitioners. Methods: In preparation for a larger trial to examine the effect of training on CAM practitioner clinical practice behaviors around tobacco cessation, this developmental study will (1) adapt an existing in-person tobacco cessation BI training program that is specifically tailored for CAM therapists for delivery via the Internet; (2) develop a novel, Web-based tool to assess CAM practitioner competence in tobacco cessation BI skills, and conduct a pilot validation study comparing the competency assessment tool to live video role plays with a standardized patient; (3) pilot test the Web-based training with 120 CAM practitioners (40 acupuncturists, 40 chiropractors, 40 massage therapists) for usability, accessibility, acceptability, and effects on practitioner knowledge, self-efficacy, and competency with tobacco cessation; and (4) conduct qualitative and quantitative formative research on factors influencing practitioner tobacco cessation clinical behaviors (eg, practice environment, peer social influence, and insurance reimbursement). Results: Web-training and competency assessment tool development and study enrollment and training activities are complete (N=203 practitioners enrolled). Training completion rates were lower than expected (36.9%, 75/203), necessitating over enrollment to ensure a sufficient number of training completers. Follow-up data collection is in progress. Data analysis will begin immediately after data collection is complete. Conclusions: To realize CAM practitioners’ potential to promote tobacco cessation and use of evidence-based treatments, there is a need to know more about the facilitative and inhibitory factors influencing CAM practitioner tobacco intervention behaviors (eg, social influence and insurance reimbursement). Given marked differences between conventional and CAM practitioners, extant knowledge about factors influencing conventional practitioner adoption of tobacco cessation behaviors cannot be confidently extrapolated to CAM practitioners. The potential impact of this study is to expand tobacco cessation and health promotion infrastructure in a new group of health practitioners who can help combat the continuing epidemic of tobacco use. %M 26740468 %R 10.2196/resprot.5061 %U http://www.researchprotocols.org/2016/1/e2/ %U https://doi.org/10.2196/resprot.5061 %U http://www.ncbi.nlm.nih.gov/pubmed/26740468 %0 Journal Article %@ 2369-3762 %I JMIR Publications Inc. %V 1 %N 2 %P e15 %T Mobile Virtual Learning Object for the Assessment of Acute Pain as a Learning Tool to Assess Acute Pain in Nursing: An Analysis of the Mental Workload %A Alvarez,Ana Graziela %A Sasso,Grace %A Iyengar,Sriram %+ Science Health Center, Department of Nursing, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Bairro Trindade, Florianópolis, 88040-900, Brazil, 55 48 3721 4910, grazielaalvarez@gmail.com %K nursing %K nursing informatics %K distance learning %K computer-assisted instruction %K educational technology %K nursing education %K acute pain %K persuasive technology %K mental workload %D 2015 %7 06.11.2015 %9 Original Paper %J JMIR Medical Education %G English %X Background: The inclusion of new technologies in education has motivated the development of studies on mental workload. These technologies are now being used in the teaching and learning process. The analysis enables identification of factors intervening in this workload as well as planning of overload prevention for educational activities using these technologies. Objective: To analyze the mental workload of an educational intervention with the Mobile Virtual Learning Object for the Assessment of Acute Pain in adults and newborns, according to the NASA Task Load Index criteria. Methods: A methodological study with data collected from 5 nurses and 75 students, from November of 2013 to February of 2014. Results: The highest students’ and specialists’ means were in the dimensions of “Mental demand” (57.20 ± 22.27; 51 ± 29.45) and “Performance” (58.47 ± 24.19; 73 ± 28.85). The specialists’ mental workload index was higher (50.20 ± 7.28) when compared with students’ (47.87 ± 16.85) on a scale from 0 to 100 (P=.557). Conclusions: The instrument allowed for the assessment of mental workload after an online educational intervention with a mobile learning virtual object. An excessive overload was not identified among participants. Assessing mental workload from the use of educational technologies at the end of a task is a key to their applicability, with the aim of providing a more effective, stimulating, and long-lasting experience of the learning process. %M 27731849 %R 10.2196/mededu.4958 %U http://mededu.jmir.org/2015/2/e15/ %U https://doi.org/10.2196/mededu.4958 %U http://www.ncbi.nlm.nih.gov/pubmed/27731849 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 9 %P e221 %T Designing and Testing an Inventory for Measuring Social Media Competency of Certified Health Education Specialists %A Alber,Julia M %A Bernhardt,Jay M %A Stellefson,Michael %A Weiler,Robert M %A Anderson-Lewis,Charkarra %A Miller,M David %A MacInnes,Jann %+ Center for Health Behavior Research, Perelman School of Medicine, University of Pennsylvania, 110 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, United States, 1 215 573 9894, alberj@upenn.edu %K social media %K health education %K professional competence %D 2015 %7 23.09.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media can promote healthy behaviors by facilitating engagement and collaboration among health professionals and the public. Thus, social media is quickly becoming a vital tool for health promotion. While guidelines and trainings exist for public health professionals, there are currently no standardized measures to assess individual social media competency among Certified Health Education Specialists (CHES) and Master Certified Health Education Specialists (MCHES). Objective: The aim of this study was to design, develop, and test the Social Media Competency Inventory (SMCI) for CHES and MCHES. Methods: The SMCI was designed in three sequential phases: (1) Conceptualization and Domain Specifications, (2) Item Development, and (3) Inventory Testing and Finalization. Phase 1 consisted of a literature review, concept operationalization, and expert reviews. Phase 2 involved an expert panel (n=4) review, think-aloud sessions with a small representative sample of CHES/MCHES (n=10), a pilot test (n=36), and classical test theory analyses to develop the initial version of the SMCI. Phase 3 included a field test of the SMCI with a random sample of CHES and MCHES (n=353), factor and Rasch analyses, and development of SMCI administration and interpretation guidelines. Results: Six constructs adapted from the unified theory of acceptance and use of technology and the integrated behavioral model were identified for assessing social media competency: (1) Social Media Self-Efficacy, (2) Social Media Experience, (3) Effort Expectancy, (4) Performance Expectancy, (5) Facilitating Conditions, and (6) Social Influence. The initial item pool included 148 items. After the pilot test, 16 items were removed or revised because of low item discrimination (r<.30), high interitem correlations (Ρ>.90), or based on feedback received from pilot participants. During the psychometric analysis of the field test data, 52 items were removed due to low discrimination, evidence of content redundancy, low R-squared value, or poor item infit or outfit. Psychometric analyses of the data revealed acceptable reliability evidence for the following scales: Social Media Self-Efficacy (alpha=.98, item reliability=.98, item separation=6.76), Social Media Experience (alpha=.98, item reliability=.98, item separation=6.24), Effort Expectancy(alpha =.74, item reliability=.95, item separation=4.15), Performance Expectancy (alpha =.81, item reliability=.99, item separation=10.09), Facilitating Conditions (alpha =.66, item reliability=.99, item separation=16.04), and Social Influence (alpha =.66, item reliability=.93, item separation=3.77). There was some evidence of local dependence among the scales, with several observed residual correlations above |.20|. Conclusions: Through the multistage instrument-development process, sufficient reliability and validity evidence was collected in support of the purpose and intended use of the SMCI. The SMCI can be used to assess the readiness of health education specialists to effectively use social media for health promotion research and practice. Future research should explore associations across constructs within the SMCI and evaluate the ability of SMCI scores to predict social media use and performance among CHES and MCHES. %M 26399428 %R 10.2196/jmir.4943 %U http://www.jmir.org/2015/9/e221/ %U https://doi.org/10.2196/jmir.4943 %U http://www.ncbi.nlm.nih.gov/pubmed/26399428 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 4 %P e97 %T Review and Evaluation of Online Tobacco Dependence Treatment Training Programs for Health Care Practitioners %A Selby,Peter %A Goncharenko,Karina %A Barker,Megan %A Fahim,Myra %A Timothy,Valerie %A Dragonetti,Rosa %A Kemper,Katherine %A Herie,Marilyn %A Hays,J Taylor %+ Centre for Addiction and Mental Health, Addictions Division, 175 College Street, 3rd Floor, Toronto, ON, M5T1P7, Canada, 1 416 535 8501 ext 36859, peter.selby@camh.ca %K distance education %K tobacco use %K health care %K smoking cessation %K tobacco dependence %K program evaluation %K continuing medical education %D 2015 %7 17.04.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Training health care professionals is associated with increased capacity to deliver evidence-based smoking cessation interventions and increased quit rates among their patients. Online training programs hold promise to provide training but questions remain regarding the quality and usability of available programs. Objective: The aim was to assess the quality of English-language online courses in tobacco dependence treatment using a validated instrument. Methods: An environmental scan was conducted using the Google search engine to identify available online tobacco dependence treatment courses. The identified courses were then evaluated using the Peer Review Rubric for Online Learning, which was selected based on its ability to evaluate instructional design. It also has clear and concise criteria descriptions to ensure uniformity of evaluations by trained experts. Results: A total of 39 courses were identified, of which 24 unique courses were assessed based on their accessibility and functionality during the period of evaluation. Overall, the course ratings indicated that 17 of 24 courses evaluated failed to meet minimal quality standards and none of the courses evaluated could be ranked as superior. However, many excelled in providing effective navigation, course rationale, and content. Many were weak in the use of instructional design elements, such as teaching effectiveness, learning strategies, instructor’s role, and assessment and evaluation. Evaluation results and suggestions for improvement were shared with course administrators. Conclusions: Based on the courses evaluated in this review, course developers are encouraged to employ best practices in instructional design, such as cohesiveness of material, linearity of design, practice exercises, problem solving, and ongoing evaluation to improve existing courses and in the design of new online learning opportunities. %M 25887187 %R 10.2196/jmir.3284 %U http://www.jmir.org/2015/4/e97/ %U https://doi.org/10.2196/jmir.3284 %U http://www.ncbi.nlm.nih.gov/pubmed/25887187